the case study approach

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The case study approach

Affiliation.

1 Division of Primary Care, The University of Nottingham, Nottingham, UK. [email protected]
PMID: 21707982
PMCID: PMC3141799
DOI: 10.1186/1471-2288-11-100

The case study approach allows in-depth, multi-faceted explorations of complex issues in their real-life settings. The value of the case study approach is well recognised in the fields of business, law and policy, but somewhat less so in health services research. Based on our experiences of conducting several health-related case studies, we reflect on the different types of case study design, the specific research questions this approach can help answer, the data sources that tend to be used, and the particular advantages and disadvantages of employing this methodological approach. The paper concludes with key pointers to aid those designing and appraising proposals for conducting case study research, and a checklist to help readers assess the quality of case study reports.

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Home » Case Study – Methods, Examples and Guide

Case Study – Methods, Examples and Guide

Table of Contents

A case study is a research method that involves an in-depth examination and analysis of a particular phenomenon or case, such as an individual, organization, community, event, or situation.

It is a qualitative research approach that aims to provide a detailed and comprehensive understanding of the case being studied. Case studies typically involve multiple sources of data, including interviews, observations, documents, and artifacts, which are analyzed using various techniques, such as content analysis, thematic analysis, and grounded theory. The findings of a case study are often used to develop theories, inform policy or practice, or generate new research questions.

Types of Case Study

Types and Methods of Case Study are as follows:

Single-Case Study

A single-case study is an in-depth analysis of a single case. This type of case study is useful when the researcher wants to understand a specific phenomenon in detail.

For Example , A researcher might conduct a single-case study on a particular individual to understand their experiences with a particular health condition or a specific organization to explore their management practices. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of a single-case study are often used to generate new research questions, develop theories, or inform policy or practice.

Multiple-Case Study

A multiple-case study involves the analysis of several cases that are similar in nature. This type of case study is useful when the researcher wants to identify similarities and differences between the cases.

For Example, a researcher might conduct a multiple-case study on several companies to explore the factors that contribute to their success or failure. The researcher collects data from each case, compares and contrasts the findings, and uses various techniques to analyze the data, such as comparative analysis or pattern-matching. The findings of a multiple-case study can be used to develop theories, inform policy or practice, or generate new research questions.

Exploratory Case Study

An exploratory case study is used to explore a new or understudied phenomenon. This type of case study is useful when the researcher wants to generate hypotheses or theories about the phenomenon.

For Example, a researcher might conduct an exploratory case study on a new technology to understand its potential impact on society. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as grounded theory or content analysis. The findings of an exploratory case study can be used to generate new research questions, develop theories, or inform policy or practice.

Descriptive Case Study

A descriptive case study is used to describe a particular phenomenon in detail. This type of case study is useful when the researcher wants to provide a comprehensive account of the phenomenon.

For Example, a researcher might conduct a descriptive case study on a particular community to understand its social and economic characteristics. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of a descriptive case study can be used to inform policy or practice or generate new research questions.

Instrumental Case Study

An instrumental case study is used to understand a particular phenomenon that is instrumental in achieving a particular goal. This type of case study is useful when the researcher wants to understand the role of the phenomenon in achieving the goal.

For Example, a researcher might conduct an instrumental case study on a particular policy to understand its impact on achieving a particular goal, such as reducing poverty. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of an instrumental case study can be used to inform policy or practice or generate new research questions.

Case Study Data Collection Methods

Here are some common data collection methods for case studies:

Interviews involve asking questions to individuals who have knowledge or experience relevant to the case study. Interviews can be structured (where the same questions are asked to all participants) or unstructured (where the interviewer follows up on the responses with further questions). Interviews can be conducted in person, over the phone, or through video conferencing.

Observations

Observations involve watching and recording the behavior and activities of individuals or groups relevant to the case study. Observations can be participant (where the researcher actively participates in the activities) or non-participant (where the researcher observes from a distance). Observations can be recorded using notes, audio or video recordings, or photographs.

Documents can be used as a source of information for case studies. Documents can include reports, memos, emails, letters, and other written materials related to the case study. Documents can be collected from the case study participants or from public sources.

Surveys involve asking a set of questions to a sample of individuals relevant to the case study. Surveys can be administered in person, over the phone, through mail or email, or online. Surveys can be used to gather information on attitudes, opinions, or behaviors related to the case study.

Artifacts are physical objects relevant to the case study. Artifacts can include tools, equipment, products, or other objects that provide insights into the case study phenomenon.

How to conduct Case Study Research

Conducting a case study research involves several steps that need to be followed to ensure the quality and rigor of the study. Here are the steps to conduct case study research:

Define the research questions: The first step in conducting a case study research is to define the research questions. The research questions should be specific, measurable, and relevant to the case study phenomenon under investigation.
Select the case: The next step is to select the case or cases to be studied. The case should be relevant to the research questions and should provide rich and diverse data that can be used to answer the research questions.
Collect data: Data can be collected using various methods, such as interviews, observations, documents, surveys, and artifacts. The data collection method should be selected based on the research questions and the nature of the case study phenomenon.
Analyze the data: The data collected from the case study should be analyzed using various techniques, such as content analysis, thematic analysis, or grounded theory. The analysis should be guided by the research questions and should aim to provide insights and conclusions relevant to the research questions.
Draw conclusions: The conclusions drawn from the case study should be based on the data analysis and should be relevant to the research questions. The conclusions should be supported by evidence and should be clearly stated.
Validate the findings: The findings of the case study should be validated by reviewing the data and the analysis with participants or other experts in the field. This helps to ensure the validity and reliability of the findings.
Write the report: The final step is to write the report of the case study research. The report should provide a clear description of the case study phenomenon, the research questions, the data collection methods, the data analysis, the findings, and the conclusions. The report should be written in a clear and concise manner and should follow the guidelines for academic writing.

Examples of Case Study

Here are some examples of case study research:

The Hawthorne Studies : Conducted between 1924 and 1932, the Hawthorne Studies were a series of case studies conducted by Elton Mayo and his colleagues to examine the impact of work environment on employee productivity. The studies were conducted at the Hawthorne Works plant of the Western Electric Company in Chicago and included interviews, observations, and experiments.
The Stanford Prison Experiment: Conducted in 1971, the Stanford Prison Experiment was a case study conducted by Philip Zimbardo to examine the psychological effects of power and authority. The study involved simulating a prison environment and assigning participants to the role of guards or prisoners. The study was controversial due to the ethical issues it raised.
The Challenger Disaster: The Challenger Disaster was a case study conducted to examine the causes of the Space Shuttle Challenger explosion in 1986. The study included interviews, observations, and analysis of data to identify the technical, organizational, and cultural factors that contributed to the disaster.
The Enron Scandal: The Enron Scandal was a case study conducted to examine the causes of the Enron Corporation’s bankruptcy in 2001. The study included interviews, analysis of financial data, and review of documents to identify the accounting practices, corporate culture, and ethical issues that led to the company’s downfall.
The Fukushima Nuclear Disaster : The Fukushima Nuclear Disaster was a case study conducted to examine the causes of the nuclear accident that occurred at the Fukushima Daiichi Nuclear Power Plant in Japan in 2011. The study included interviews, analysis of data, and review of documents to identify the technical, organizational, and cultural factors that contributed to the disaster.

Application of Case Study

Case studies have a wide range of applications across various fields and industries. Here are some examples:

Business and Management

Case studies are widely used in business and management to examine real-life situations and develop problem-solving skills. Case studies can help students and professionals to develop a deep understanding of business concepts, theories, and best practices.

Case studies are used in healthcare to examine patient care, treatment options, and outcomes. Case studies can help healthcare professionals to develop critical thinking skills, diagnose complex medical conditions, and develop effective treatment plans.

Case studies are used in education to examine teaching and learning practices. Case studies can help educators to develop effective teaching strategies, evaluate student progress, and identify areas for improvement.

Social Sciences

Case studies are widely used in social sciences to examine human behavior, social phenomena, and cultural practices. Case studies can help researchers to develop theories, test hypotheses, and gain insights into complex social issues.

Law and Ethics

Case studies are used in law and ethics to examine legal and ethical dilemmas. Case studies can help lawyers, policymakers, and ethical professionals to develop critical thinking skills, analyze complex cases, and make informed decisions.

Purpose of Case Study

The purpose of a case study is to provide a detailed analysis of a specific phenomenon, issue, or problem in its real-life context. A case study is a qualitative research method that involves the in-depth exploration and analysis of a particular case, which can be an individual, group, organization, event, or community.

The primary purpose of a case study is to generate a comprehensive and nuanced understanding of the case, including its history, context, and dynamics. Case studies can help researchers to identify and examine the underlying factors, processes, and mechanisms that contribute to the case and its outcomes. This can help to develop a more accurate and detailed understanding of the case, which can inform future research, practice, or policy.

Case studies can also serve other purposes, including:

Illustrating a theory or concept: Case studies can be used to illustrate and explain theoretical concepts and frameworks, providing concrete examples of how they can be applied in real-life situations.
Developing hypotheses: Case studies can help to generate hypotheses about the causal relationships between different factors and outcomes, which can be tested through further research.
Providing insight into complex issues: Case studies can provide insights into complex and multifaceted issues, which may be difficult to understand through other research methods.
Informing practice or policy: Case studies can be used to inform practice or policy by identifying best practices, lessons learned, or areas for improvement.

Advantages of Case Study Research

There are several advantages of case study research, including:

In-depth exploration: Case study research allows for a detailed exploration and analysis of a specific phenomenon, issue, or problem in its real-life context. This can provide a comprehensive understanding of the case and its dynamics, which may not be possible through other research methods.
Rich data: Case study research can generate rich and detailed data, including qualitative data such as interviews, observations, and documents. This can provide a nuanced understanding of the case and its complexity.
Holistic perspective: Case study research allows for a holistic perspective of the case, taking into account the various factors, processes, and mechanisms that contribute to the case and its outcomes. This can help to develop a more accurate and comprehensive understanding of the case.
Theory development: Case study research can help to develop and refine theories and concepts by providing empirical evidence and concrete examples of how they can be applied in real-life situations.
Practical application: Case study research can inform practice or policy by identifying best practices, lessons learned, or areas for improvement.
Contextualization: Case study research takes into account the specific context in which the case is situated, which can help to understand how the case is influenced by the social, cultural, and historical factors of its environment.

Limitations of Case Study Research

There are several limitations of case study research, including:

Limited generalizability : Case studies are typically focused on a single case or a small number of cases, which limits the generalizability of the findings. The unique characteristics of the case may not be applicable to other contexts or populations, which may limit the external validity of the research.
Biased sampling: Case studies may rely on purposive or convenience sampling, which can introduce bias into the sample selection process. This may limit the representativeness of the sample and the generalizability of the findings.
Subjectivity: Case studies rely on the interpretation of the researcher, which can introduce subjectivity into the analysis. The researcher’s own biases, assumptions, and perspectives may influence the findings, which may limit the objectivity of the research.
Limited control: Case studies are typically conducted in naturalistic settings, which limits the control that the researcher has over the environment and the variables being studied. This may limit the ability to establish causal relationships between variables.
Time-consuming: Case studies can be time-consuming to conduct, as they typically involve a detailed exploration and analysis of a specific case. This may limit the feasibility of conducting multiple case studies or conducting case studies in a timely manner.
Resource-intensive: Case studies may require significant resources, including time, funding, and expertise. This may limit the ability of researchers to conduct case studies in resource-constrained settings.

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The Ultimate Guide to Qualitative Research - Part 1: The Basics

Introduction and overview
What is qualitative research?
What is qualitative data?
Examples of qualitative data
Qualitative vs. quantitative research
Mixed methods
Qualitative research preparation
Theoretical perspective
Theoretical framework
Literature reviews

Research question

Conceptual framework
Conceptual vs. theoretical framework

Data collection

Qualitative research methods
Focus groups
Observational research

What is a case study?

Applications for case study research, what is a good case study, process of case study design, benefits and limitations of case studies.

Ethnographical research
Ethical considerations
Confidentiality and privacy
Power dynamics
Reflexivity

Case studies

Case studies are essential to qualitative research , offering a lens through which researchers can investigate complex phenomena within their real-life contexts. This chapter explores the concept, purpose, applications, examples, and types of case studies and provides guidance on how to conduct case study research effectively.

Whereas quantitative methods look at phenomena at scale, case study research looks at a concept or phenomenon in considerable detail. While analyzing a single case can help understand one perspective regarding the object of research inquiry, analyzing multiple cases can help obtain a more holistic sense of the topic or issue. Let's provide a basic definition of a case study, then explore its characteristics and role in the qualitative research process.

Definition of a case study

A case study in qualitative research is a strategy of inquiry that involves an in-depth investigation of a phenomenon within its real-world context. It provides researchers with the opportunity to acquire an in-depth understanding of intricate details that might not be as apparent or accessible through other methods of research. The specific case or cases being studied can be a single person, group, or organization – demarcating what constitutes a relevant case worth studying depends on the researcher and their research question .

Among qualitative research methods , a case study relies on multiple sources of evidence, such as documents, artifacts, interviews , or observations , to present a complete and nuanced understanding of the phenomenon under investigation. The objective is to illuminate the readers' understanding of the phenomenon beyond its abstract statistical or theoretical explanations.

Characteristics of case studies

Case studies typically possess a number of distinct characteristics that set them apart from other research methods. These characteristics include a focus on holistic description and explanation, flexibility in the design and data collection methods, reliance on multiple sources of evidence, and emphasis on the context in which the phenomenon occurs.

Furthermore, case studies can often involve a longitudinal examination of the case, meaning they study the case over a period of time. These characteristics allow case studies to yield comprehensive, in-depth, and richly contextualized insights about the phenomenon of interest.

The role of case studies in research

Case studies hold a unique position in the broader landscape of research methods aimed at theory development. They are instrumental when the primary research interest is to gain an intensive, detailed understanding of a phenomenon in its real-life context.

In addition, case studies can serve different purposes within research - they can be used for exploratory, descriptive, or explanatory purposes, depending on the research question and objectives. This flexibility and depth make case studies a valuable tool in the toolkit of qualitative researchers.

Remember, a well-conducted case study can offer a rich, insightful contribution to both academic and practical knowledge through theory development or theory verification, thus enhancing our understanding of complex phenomena in their real-world contexts.

What is the purpose of a case study?

Case study research aims for a more comprehensive understanding of phenomena, requiring various research methods to gather information for qualitative analysis . Ultimately, a case study can allow the researcher to gain insight into a particular object of inquiry and develop a theoretical framework relevant to the research inquiry.

Why use case studies in qualitative research?

Using case studies as a research strategy depends mainly on the nature of the research question and the researcher's access to the data.

Conducting case study research provides a level of detail and contextual richness that other research methods might not offer. They are beneficial when there's a need to understand complex social phenomena within their natural contexts.

The explanatory, exploratory, and descriptive roles of case studies

Case studies can take on various roles depending on the research objectives. They can be exploratory when the research aims to discover new phenomena or define new research questions; they are descriptive when the objective is to depict a phenomenon within its context in a detailed manner; and they can be explanatory if the goal is to understand specific relationships within the studied context. Thus, the versatility of case studies allows researchers to approach their topic from different angles, offering multiple ways to uncover and interpret the data .

The impact of case studies on knowledge development

Case studies play a significant role in knowledge development across various disciplines. Analysis of cases provides an avenue for researchers to explore phenomena within their context based on the collected data.

This can result in the production of rich, practical insights that can be instrumental in both theory-building and practice. Case studies allow researchers to delve into the intricacies and complexities of real-life situations, uncovering insights that might otherwise remain hidden.

Types of case studies

In qualitative research , a case study is not a one-size-fits-all approach. Depending on the nature of the research question and the specific objectives of the study, researchers might choose to use different types of case studies. These types differ in their focus, methodology, and the level of detail they provide about the phenomenon under investigation.

Understanding these types is crucial for selecting the most appropriate approach for your research project and effectively achieving your research goals. Let's briefly look at the main types of case studies.

Exploratory case studies

Exploratory case studies are typically conducted to develop a theory or framework around an understudied phenomenon. They can also serve as a precursor to a larger-scale research project. Exploratory case studies are useful when a researcher wants to identify the key issues or questions which can spur more extensive study or be used to develop propositions for further research. These case studies are characterized by flexibility, allowing researchers to explore various aspects of a phenomenon as they emerge, which can also form the foundation for subsequent studies.

Descriptive case studies

Descriptive case studies aim to provide a complete and accurate representation of a phenomenon or event within its context. These case studies are often based on an established theoretical framework, which guides how data is collected and analyzed. The researcher is concerned with describing the phenomenon in detail, as it occurs naturally, without trying to influence or manipulate it.

Explanatory case studies

Explanatory case studies are focused on explanation - they seek to clarify how or why certain phenomena occur. Often used in complex, real-life situations, they can be particularly valuable in clarifying causal relationships among concepts and understanding the interplay between different factors within a specific context.

Intrinsic, instrumental, and collective case studies

These three categories of case studies focus on the nature and purpose of the study. An intrinsic case study is conducted when a researcher has an inherent interest in the case itself. Instrumental case studies are employed when the case is used to provide insight into a particular issue or phenomenon. A collective case study, on the other hand, involves studying multiple cases simultaneously to investigate some general phenomena.

Each type of case study serves a different purpose and has its own strengths and challenges. The selection of the type should be guided by the research question and objectives, as well as the context and constraints of the research.

The flexibility, depth, and contextual richness offered by case studies make this approach an excellent research method for various fields of study. They enable researchers to investigate real-world phenomena within their specific contexts, capturing nuances that other research methods might miss. Across numerous fields, case studies provide valuable insights into complex issues.

Critical information systems research

Case studies provide a detailed understanding of the role and impact of information systems in different contexts. They offer a platform to explore how information systems are designed, implemented, and used and how they interact with various social, economic, and political factors. Case studies in this field often focus on examining the intricate relationship between technology, organizational processes, and user behavior, helping to uncover insights that can inform better system design and implementation.

Health research

Health research is another field where case studies are highly valuable. They offer a way to explore patient experiences, healthcare delivery processes, and the impact of various interventions in a real-world context.

Case studies can provide a deep understanding of a patient's journey, giving insights into the intricacies of disease progression, treatment effects, and the psychosocial aspects of health and illness.

Asthma research studies

Specifically within medical research, studies on asthma often employ case studies to explore the individual and environmental factors that influence asthma development, management, and outcomes. A case study can provide rich, detailed data about individual patients' experiences, from the triggers and symptoms they experience to the effectiveness of various management strategies. This can be crucial for developing patient-centered asthma care approaches.

Other fields

Apart from the fields mentioned, case studies are also extensively used in business and management research, education research, and political sciences, among many others. They provide an opportunity to delve into the intricacies of real-world situations, allowing for a comprehensive understanding of various phenomena.

Case studies, with their depth and contextual focus, offer unique insights across these varied fields. They allow researchers to illuminate the complexities of real-life situations, contributing to both theory and practice.

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Understanding the key elements of case study design is crucial for conducting rigorous and impactful case study research. A well-structured design guides the researcher through the process, ensuring that the study is methodologically sound and its findings are reliable and valid. The main elements of case study design include the research question , propositions, units of analysis, and the logic linking the data to the propositions.

The research question is the foundation of any research study. A good research question guides the direction of the study and informs the selection of the case, the methods of collecting data, and the analysis techniques. A well-formulated research question in case study research is typically clear, focused, and complex enough to merit further detailed examination of the relevant case(s).

Propositions

Propositions, though not necessary in every case study, provide a direction by stating what we might expect to find in the data collected. They guide how data is collected and analyzed by helping researchers focus on specific aspects of the case. They are particularly important in explanatory case studies, which seek to understand the relationships among concepts within the studied phenomenon.

Units of analysis

The unit of analysis refers to the case, or the main entity or entities that are being analyzed in the study. In case study research, the unit of analysis can be an individual, a group, an organization, a decision, an event, or even a time period. It's crucial to clearly define the unit of analysis, as it shapes the qualitative data analysis process by allowing the researcher to analyze a particular case and synthesize analysis across multiple case studies to draw conclusions.

Argumentation

This refers to the inferential model that allows researchers to draw conclusions from the data. The researcher needs to ensure that there is a clear link between the data, the propositions (if any), and the conclusions drawn. This argumentation is what enables the researcher to make valid and credible inferences about the phenomenon under study.

Understanding and carefully considering these elements in the design phase of a case study can significantly enhance the quality of the research. It can help ensure that the study is methodologically sound and its findings contribute meaningful insights about the case.

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Conducting a case study involves several steps, from defining the research question and selecting the case to collecting and analyzing data . This section outlines these key stages, providing a practical guide on how to conduct case study research.

Defining the research question

The first step in case study research is defining a clear, focused research question. This question should guide the entire research process, from case selection to analysis. It's crucial to ensure that the research question is suitable for a case study approach. Typically, such questions are exploratory or descriptive in nature and focus on understanding a phenomenon within its real-life context.

Selecting and defining the case

The selection of the case should be based on the research question and the objectives of the study. It involves choosing a unique example or a set of examples that provide rich, in-depth data about the phenomenon under investigation. After selecting the case, it's crucial to define it clearly, setting the boundaries of the case, including the time period and the specific context.

Previous research can help guide the case study design. When considering a case study, an example of a case could be taken from previous case study research and used to define cases in a new research inquiry. Considering recently published examples can help understand how to select and define cases effectively.

Developing a detailed case study protocol

A case study protocol outlines the procedures and general rules to be followed during the case study. This includes the data collection methods to be used, the sources of data, and the procedures for analysis. Having a detailed case study protocol ensures consistency and reliability in the study.

The protocol should also consider how to work with the people involved in the research context to grant the research team access to collecting data. As mentioned in previous sections of this guide, establishing rapport is an essential component of qualitative research as it shapes the overall potential for collecting and analyzing data.

Collecting data

Gathering data in case study research often involves multiple sources of evidence, including documents, archival records, interviews, observations, and physical artifacts. This allows for a comprehensive understanding of the case. The process for gathering data should be systematic and carefully documented to ensure the reliability and validity of the study.

Analyzing and interpreting data

The next step is analyzing the data. This involves organizing the data , categorizing it into themes or patterns , and interpreting these patterns to answer the research question. The analysis might also involve comparing the findings with prior research or theoretical propositions.

Writing the case study report

The final step is writing the case study report . This should provide a detailed description of the case, the data, the analysis process, and the findings. The report should be clear, organized, and carefully written to ensure that the reader can understand the case and the conclusions drawn from it.

Each of these steps is crucial in ensuring that the case study research is rigorous, reliable, and provides valuable insights about the case.

The type, depth, and quality of data in your study can significantly influence the validity and utility of the study. In case study research, data is usually collected from multiple sources to provide a comprehensive and nuanced understanding of the case. This section will outline the various methods of collecting data used in case study research and discuss considerations for ensuring the quality of the data.

Interviews are a common method of gathering data in case study research. They can provide rich, in-depth data about the perspectives, experiences, and interpretations of the individuals involved in the case. Interviews can be structured , semi-structured , or unstructured , depending on the research question and the degree of flexibility needed.

Observations

Observations involve the researcher observing the case in its natural setting, providing first-hand information about the case and its context. Observations can provide data that might not be revealed in interviews or documents, such as non-verbal cues or contextual information.

Documents and artifacts

Documents and archival records provide a valuable source of data in case study research. They can include reports, letters, memos, meeting minutes, email correspondence, and various public and private documents related to the case.

These records can provide historical context, corroborate evidence from other sources, and offer insights into the case that might not be apparent from interviews or observations.

Physical artifacts refer to any physical evidence related to the case, such as tools, products, or physical environments. These artifacts can provide tangible insights into the case, complementing the data gathered from other sources.

Ensuring the quality of data collection

Determining the quality of data in case study research requires careful planning and execution. It's crucial to ensure that the data is reliable, accurate, and relevant to the research question. This involves selecting appropriate methods of collecting data, properly training interviewers or observers, and systematically recording and storing the data. It also includes considering ethical issues related to collecting and handling data, such as obtaining informed consent and ensuring the privacy and confidentiality of the participants.

Data analysis

Analyzing case study research involves making sense of the rich, detailed data to answer the research question. This process can be challenging due to the volume and complexity of case study data. However, a systematic and rigorous approach to analysis can ensure that the findings are credible and meaningful. This section outlines the main steps and considerations in analyzing data in case study research.

Organizing the data

The first step in the analysis is organizing the data. This involves sorting the data into manageable sections, often according to the data source or the theme. This step can also involve transcribing interviews, digitizing physical artifacts, or organizing observational data.

Categorizing and coding the data

Once the data is organized, the next step is to categorize or code the data. This involves identifying common themes, patterns, or concepts in the data and assigning codes to relevant data segments. Coding can be done manually or with the help of software tools, and in either case, qualitative analysis software can greatly facilitate the entire coding process. Coding helps to reduce the data to a set of themes or categories that can be more easily analyzed.

Identifying patterns and themes

After coding the data, the researcher looks for patterns or themes in the coded data. This involves comparing and contrasting the codes and looking for relationships or patterns among them. The identified patterns and themes should help answer the research question.

Interpreting the data

Once patterns and themes have been identified, the next step is to interpret these findings. This involves explaining what the patterns or themes mean in the context of the research question and the case. This interpretation should be grounded in the data, but it can also involve drawing on theoretical concepts or prior research.

Verification of the data

The last step in the analysis is verification. This involves checking the accuracy and consistency of the analysis process and confirming that the findings are supported by the data. This can involve re-checking the original data, checking the consistency of codes, or seeking feedback from research participants or peers.

Like any research method , case study research has its strengths and limitations. Researchers must be aware of these, as they can influence the design, conduct, and interpretation of the study.

Understanding the strengths and limitations of case study research can also guide researchers in deciding whether this approach is suitable for their research question . This section outlines some of the key strengths and limitations of case study research.

Benefits include the following:

Rich, detailed data: One of the main strengths of case study research is that it can generate rich, detailed data about the case. This can provide a deep understanding of the case and its context, which can be valuable in exploring complex phenomena.
Flexibility: Case study research is flexible in terms of design , data collection , and analysis . A sufficient degree of flexibility allows the researcher to adapt the study according to the case and the emerging findings.
Real-world context: Case study research involves studying the case in its real-world context, which can provide valuable insights into the interplay between the case and its context.
Multiple sources of evidence: Case study research often involves collecting data from multiple sources , which can enhance the robustness and validity of the findings.

On the other hand, researchers should consider the following limitations:

Generalizability: A common criticism of case study research is that its findings might not be generalizable to other cases due to the specificity and uniqueness of each case.
Time and resource intensive: Case study research can be time and resource intensive due to the depth of the investigation and the amount of collected data.
Complexity of analysis: The rich, detailed data generated in case study research can make analyzing the data challenging.
Subjectivity: Given the nature of case study research, there may be a higher degree of subjectivity in interpreting the data , so researchers need to reflect on this and transparently convey to audiences how the research was conducted.

Being aware of these strengths and limitations can help researchers design and conduct case study research effectively and interpret and report the findings appropriately.

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Case Study | Definition, Examples & Methods

Case Study | Definition, Examples & Methods

Published on 5 May 2022 by Shona McCombes . Revised on 30 January 2023.

A case study is a detailed study of a specific subject, such as a person, group, place, event, organisation, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research.

A case study research design usually involves qualitative methods , but quantitative methods are sometimes also used. Case studies are good for describing , comparing, evaluating, and understanding different aspects of a research problem .

When to do a case study, step 1: select a case, step 2: build a theoretical framework, step 3: collect your data, step 4: describe and analyse the case.

A case study is an appropriate research design when you want to gain concrete, contextual, in-depth knowledge about a specific real-world subject. It allows you to explore the key characteristics, meanings, and implications of the case.

Case studies are often a good choice in a thesis or dissertation . They keep your project focused and manageable when you don’t have the time or resources to do large-scale research.

You might use just one complex case study where you explore a single subject in depth, or conduct multiple case studies to compare and illuminate different aspects of your research problem.

Case study examples
Research question	Case study
What are the ecological effects of wolf reintroduction?	Case study of wolf reintroduction in Yellowstone National Park in the US
How do populist politicians use narratives about history to gain support?	Case studies of Hungarian prime minister Viktor Orbán and US president Donald Trump
How can teachers implement active learning strategies in mixed-level classrooms?	Case study of a local school that promotes active learning
What are the main advantages and disadvantages of wind farms for rural communities?	Case studies of three rural wind farm development projects in different parts of the country
How are viral marketing strategies changing the relationship between companies and consumers?	Case study of the iPhone X marketing campaign
How do experiences of work in the gig economy differ by gender, race, and age?	Case studies of Deliveroo and Uber drivers in London

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Once you have developed your problem statement and research questions , you should be ready to choose the specific case that you want to focus on. A good case study should have the potential to:

Provide new or unexpected insights into the subject
Challenge or complicate existing assumptions and theories
Propose practical courses of action to resolve a problem
Open up new directions for future research

Unlike quantitative or experimental research, a strong case study does not require a random or representative sample. In fact, case studies often deliberately focus on unusual, neglected, or outlying cases which may shed new light on the research problem.

If you find yourself aiming to simultaneously investigate and solve an issue, consider conducting action research . As its name suggests, action research conducts research and takes action at the same time, and is highly iterative and flexible.

However, you can also choose a more common or representative case to exemplify a particular category, experience, or phenomenon.

While case studies focus more on concrete details than general theories, they should usually have some connection with theory in the field. This way the case study is not just an isolated description, but is integrated into existing knowledge about the topic. It might aim to:

Exemplify a theory by showing how it explains the case under investigation
Expand on a theory by uncovering new concepts and ideas that need to be incorporated
Challenge a theory by exploring an outlier case that doesn’t fit with established assumptions

To ensure that your analysis of the case has a solid academic grounding, you should conduct a literature review of sources related to the topic and develop a theoretical framework . This means identifying key concepts and theories to guide your analysis and interpretation.

There are many different research methods you can use to collect data on your subject. Case studies tend to focus on qualitative data using methods such as interviews, observations, and analysis of primary and secondary sources (e.g., newspaper articles, photographs, official records). Sometimes a case study will also collect quantitative data .

The aim is to gain as thorough an understanding as possible of the case and its context.

In writing up the case study, you need to bring together all the relevant aspects to give as complete a picture as possible of the subject.

How you report your findings depends on the type of research you are doing. Some case studies are structured like a standard scientific paper or thesis, with separate sections or chapters for the methods , results , and discussion .

Others are written in a more narrative style, aiming to explore the case from various angles and analyse its meanings and implications (for example, by using textual analysis or discourse analysis ).

In all cases, though, make sure to give contextual details about the case, connect it back to the literature and theory, and discuss how it fits into wider patterns or debates.

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22 Case Study Research: In-Depth Understanding in Context

Helen Simons, School of Education, University of Southampton

Published: 01 July 2014
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This chapter explores case study as a major approach to research and evaluation. After first noting various contexts in which case studies are commonly used, the chapter focuses on case study research directly Strengths and potential problematic issues are outlined and then key phases of the process. The chapter emphasizes how important it is to design the case, to collect and interpret data in ways that highlight the qualitative, to have an ethical practice that values multiple perspectives and political interests, and to report creatively to facilitate use in policy making and practice. Finally, it explores how to generalize from the single case. Concluding questions center on the need to think more imaginatively about design and the range of methods and forms of reporting requiredto persuade audiences to value qualitative ways of knowing in case study research.

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Implement Sci Commun

The “case” for case studies: why we need high-quality examples of global implementation research

Blythe beecroft.

1 Fogarty International Center, US National Institutes of Health, Bethesda, USA

Rachel Sturke

2 National Cancer Institute, US National Institutes of Health, Bethesda, USA

Rohit Ramaswamy

3 Cincinnati Children’s Hospital Medical Center, Cincinnati, USA

Associated Data

Not applicable.

Rigorous and systematic documented examples of implementation research in global contexts can be a valuable resource and help build research capacity. In the context of low- and middle-income countries (LMICs), there is a need for practical examples of how to conduct implementation studies. To address this gap, Fogarty’s Center for Global Health Studies in collaboration with the Cincinnati Children's Hospital Medical Center and the National Cancer Institute is commissioning a collection of implementation science case studies in LMICs that describe key components of conducting implementation research, including how to select, adapt, and apply implementation science models, theories, and frameworks to these settings; develop and test implementation strategies; and evaluate implementation processes and outcomes. The case studies describe implementation research in various disease areas in LMICs around the world. This commentary highlights the value of case study methods commonly used in law and business schools as a source of “thick” (i.e., context-rich) description and a teaching tool for global implementation researchers. It addresses the independent merit of case studies as an evaluation approach for disseminating high-quality research in a format that is useful to a broad range of stakeholders. This commentary finally describes an approach for developing high-quality case studies of global implementation research, in order to be of value to a broad audience of researchers and practitioners.

Contributions to the literature

Reinforcing the need for “thick” (i.e., context-rich) descriptions of implementation studies
Highlighting the utility of case studies as a dissemination strategy for researchers, practitioners, and policymakers
Articulating the value of detailed case studies as a teaching tool for global implementation researchers
Describing a method for developing high-quality case studies of global implementation research

Research capacity for implementation science remains limited in low- and middle-income countries (LMICs). Various stakeholders, including NIH-funded implementation researchers and practitioners, often inquire about how to apply implementation science methods and have requested additional resources and training to support implementation capacity building. This is in part due to a dearth of practical examples for both researchers and practitioners of how to select, adapt, and apply implementation science models, theories, and frameworks to these settings; how to evaluate implementation processes and outcomes; and how to develop and test implementation strategies. The need for detailed documentation of implementation research in all settings has been well established, and guidelines for documentation of implementation research studies have been created [ 1 , 2 ]. But the mere availability of checklists and guidelines in and of themselves does not result in comprehensive documentation that is useful for learning, as has been pointed out by many systematic reviews of implementation science and quality improvement studies ([ 3 , 4 ]). It has also been observed that documentation alone is not enough, and there is a need for mentors to translate abstract theories into context-appropriate research designs and practice approaches [ 5 ]. Because of the especially acute shortage of mentors and coaches in LMIC settings, we propose that documentation with “thick” descriptions that go beyond checklists and guidelines are needed to make the field more useful to emerging professionals [ 6 ]. We suggest that the case study method intended to “explore the space between the world of theory and the experience of practice” [ 7 ] that has been used successfully for over a century by law and business schools as a teaching aid can be of value to develop detailed narratives of implementation research projects. In this definition, we are not referring to the case study as a qualitative research method [ 8 ], but as a rich and detailed method of retrospective documentation to aid teaching, practice, and research. In this context, our case studies are akin to “single-institution or single-patient descriptions” [ 9 ] called “case reports” or “case examples” in other fields. As these terms are rarely used in global health, we have used the words “case studies” in this paper but reiterate that they do not refer to case study research designs.

Fogarty’s Center for Global Health Studies (CGHS) in collaboration with the Cincinnati Children's Hospital Medical Center and the National Cancer Institute (NCI) is commissioning a collection of implementation science case studies that describe implementation research focusing on various disease areas in different (LMIC) contexts around the world. These case study descriptions will provide guidance on the process of conducting implementation science studies and will highlight the impact these studies have had on practice and policy in global health contexts. This brief note makes a case for using case studies to document and disseminate implementation research, describes the CGHS approach to case study development and poses evaluation questions that need to be answered to better understand the utility of case studies. This effort is intended to develop a set of useful examples for LMIC researchers, practitioners, and policymakers, but also to assess and improve the use of case studies as a tested documentation methodology in implementation research.

The “case” for case studies

A preliminary landscape analysis of the field conducted by CGHS found that there are not many descriptions of global implementation science projects in a case study format in the peer-reviewed or gray literature, and those that exist are embedded in the content of academic teaching materials. There is not a cohesive collection, especially relating to health, that illustrates how implementation research has been conducted in varied organizations, countries, or disease areas. This new collection will add value in three different ways: as a dissemination strategy, as a tool for capacity building, and as a vehicle for stimulating better research.

Case studies as a dissemination strategy

Case studies have independent merit as an evaluation approach for disseminating high-quality research in a format that is useful to a broad range of stakeholders. The Medical Research Council (MRC) has recommended process evaluation as a useful approach to examine complex implementation, mechanisms of impact, and context [ 10 ]. Guidelines on documentation of implementation recommend that researchers should provide “detailed descriptions of interventions (and implementation strategies) in published papers, clarify assumed change processes and design principles, provide access to manuals and protocols that provide information about the clinical interventions or implementation strategies, and give detailed descriptions of active control conditions” [ 1 ]. Case studies can be thought of as a form of post hoc process evaluation, to disseminate how the delivery of an intervention is achieved, the mechanisms by which implementation strategies produce change, or how context impacts implementation and related outcomes.

Case studies as a capacity building tool

In addition, case studies can address the universal recognition of the need for more capacity building in Implementation Science , especially in LMIC settings. Case studies have been shown to address common pedagogical challenges in helping students learn by allowing students to dissect and explore limitations, adaptations, and utilization of theories, thereby creating a bridge between theories presented in a classroom and their application in the field [ 11 ]. A recent learning needs assessment for implementation researchers, practitioners, and policymakers in LMICs conducted by Turner et al. [ 12 ] reflected a universal consensus on the need for context-specific knowledge about how to apply implementation science in practice, delivered in an interactive format supported by mentorship. A collection of case studies is a valuable and scalable resource to meet this need.

Using case studies to strengthen implementation research

Descriptions of research using studies can illustrate not just whether implementation research had an impact on practice and policy, but how, why, under what circumstances, and to whom, which is the ultimate goal of generating generalizable knowledge about how to implement. Using diverse cases to demonstrate how a variety of research designs have been used to answer complex implementation questions provides researchers with a palette of design options and examples of their use. A framework developed by Minary et al. [ 13 ] illustrates the wide variety of research designs that are useful for complex interventions, depending on whether the emphasis is on internal and external validity or whether knowledge about content and process or about outcomes is more important. A collection of case studies would be invaluable to researchers seeking to develop appropriate designs for their work. In addition, the detailed documentation provided through these case descriptions will hopefully motivate researchers to document their own studies better using the guidelines described earlier.

Developing and testing the case study creation process: the CGHS approach

Writing case studies that satisfy the objectives described above is an implementation science undertaking in itself that requires the engagement of a variety of stakeholders and planned implementation strategies. The CGHS team responsible for commissioning the case studies began this process in 2017 and followed the approach detailed below to test the process of case study development.

Conducted 25+ consultations with various implementation science experts on gaps in the field and the relevance of global case studies
Convened a 15-member Steering Committee 1 of implementation scientists with diverse expertise, from various academic institutions and NIH institutes to serve as technical experts and to help guide the development and execution of the project
Developed a case study protocol in partnership with the Steering Committee to guide the inclusion of key elements in the case studies
Commissioned two pilot cases 2 to assess the feasibility and utility of the case study protocol and elicited feedback on the writing experience and how it could be improved as the collection expands
Led an iterative pilot writing process where each case study writing team developed several drafts, which were reviewed by CGHS staff and a designated member of the Steering Committee
Truncated and adjusted the protocol in response to input from the pilot case study authors teams
Developed a comprehensive grid with the Steering Committee, outlining the key dimensions of implementation science that are significant and would be important areas of focus for future case studies. The grid will be used to evaluate potential case applicants and is intended to help foster diversity of focus and content, in addition to geography

Implementing the process: the call for case studies

In March of 2021, CGHS issued a closed call for case studies to solicit applications from a pool of researchers. Potential applicants completed the comprehensive grid in addition to a case study proposal. Applicants will go through a three-tier screening and review process. CGHS will initially screen the applications for completeness to ensure all required elements are present. Each case study application will then be reviewed by two Steering Committee members for content and scientific rigor and given a numerical score based on the selection criteria. Finally, the CGHS team will screen the applications to ensure diversity of implementation elements, geography, and disease area. Approximately 10 case studies will be selected for development in an iterative process. Each case team will present their case drafts to the Steering Committee, which will collectively workshop the drafts in multiple sittings, drawing on the committee’s implementation science expertise. Once case study manuscripts are accepted by the Steering Committee, they will be submitted to Implementation Science Communications for independent review by the journal. CGHS intends for the case studies to be published collectively, but on a rolling basis as they are accepted for publication.

Future research: evaluating the effectiveness of the case study approach

This commentary has put forth arguments for the potential value of case studies for documenting implementation research for researchers, practitioners, and policymakers. Case studies not only provide a way to underscore how implementation science can advance practice and policy in LMICs, but also offer guidance on how to conduct implementation research tailored to global contexts. However, there is little empirical evidence about the validity of these arguments. The creation of this body of case studies will allow us to study why, how, how often, and by whom these case studies are used. This is a valuable opportunity to learn and use that information to better inform future use of this approach as a capacity-building or dissemination strategy.

Conclusions

Similar to their use in law and business, case study descriptions of implementation research could be an important mechanism to counteract the paucity of training programs and mentors to meet the demands of global health researchers. If the evaluation results indicate that the case study creation process produces useful products that enhance learning to improve future implementation research, a mechanism needs to be put in place to create more case studies than the small set that can be generated through this initiative. There will be a need to create a set of documentation guidelines that complement those that currently exist and a mechanism to solicit, review, publish, and disseminate case studies from a wide variety of researchers and practitioners. Journals such as Implementation Science or Implementation Science Communications can facilitate this effort by either creating a new article type or by considering a new journal with a focus on rigorous and systematic case study descriptions of implementation research and practice. An example that could serve as a guide is BMJ Open Quality , which is a peer-reviewed, open-access journal focused on healthcare improvement. In addition to original research and systematic reviews, the journal publishes two article types: Quality Improvement Report and Quality Education Report to document healthcare quality improvement programs and training. The journal offers resources for authors to document their work rigorously. Recently, a new journal titled BMJ Open Quality South Asia has been released to disseminate regional research. We hope that our efforts in sponsoring and publishing these cases, and in setting up a process to support their creation, will make an important contribution to the field and become a mechanism for sharing knowledge that accelerates the growth of implementation science in LMIC settings.

Acknowledgements

The findings and conclusions in this manuscript are those of the authors and do not necessarily represent any official position or policy of the US National Institutes of Health or the US Department of Health and Human Services or any other institutions with which authors are affiliated.

Abbreviations

LMICs	Low- and middle-income countries
CGHS	Center for Global Health Studies
NCI	National Cancer Institute
MRC	Medical Research Council

Authors’ contributions

BB, RS, and GN contributed to the conceptualization of the manuscript with leadership from RR. BB and RS drafted the main text. RR and GN reviewed and contributed additional content to further develop the text. All authors have read and agreed to the contents of the final draft of the manuscript.

Availability of data and materials

Declarations.

The authors declare that they have no competing interests.

1 Rohit Ramaswamy, CCHMC, Gila Neta, NCI NIH, Theresa Betancourt, BC, Ross Brownson, WASU, David Chambers, NCI NIH, Sharon Straus, University of Toronto, Greg Aarons, UCSD, Bryan Weiner, UW, Sonia Lee, NICHD NIH, Andrea Horvath Marques, NIMH NIH, Susannah Allison, NIMH NIH, Suzy Pollard, NIMH NIH, Chris Gordon, NIMH NIH, Kenny Sherr, UW, Usman Hamdani, HDR Foundation Pakistan, Linda Kupfer, FIC NIH

2 The first pilot case was led by the Human Development Research Foundation (HDRF) in Pakistan and examines scaling up evidenced-based care for children with developmental disorders in rural Pakistan. The second pilot was led by Boston College and investigates alternate delivery platforms and implementation models for bringing evidence-based behavioral Interventions to scale for youth facing adversity in Sierra Leone to close the mental health treatment gap.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open access
Published: 27 June 2011

The case study approach

Sarah Crowe 1 ,
Kathrin Cresswell 2 ,
Ann Robertson 2 ,
Guro Huby 3 ,
Anthony Avery 1 &
Aziz Sheikh 2

BMC Medical Research Methodology volume 11 , Article number: 100 ( 2011 ) Cite this article

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Introduction

The case study approach is particularly useful to employ when there is a need to obtain an in-depth appreciation of an issue, event or phenomenon of interest, in its natural real-life context. Our aim in writing this piece is to provide insights into when to consider employing this approach and an overview of key methodological considerations in relation to the design, planning, analysis, interpretation and reporting of case studies.

The illustrative 'grand round', 'case report' and 'case series' have a long tradition in clinical practice and research. Presenting detailed critiques, typically of one or more patients, aims to provide insights into aspects of the clinical case and, in doing so, illustrate broader lessons that may be learnt. In research, the conceptually-related case study approach can be used, for example, to describe in detail a patient's episode of care, explore professional attitudes to and experiences of a new policy initiative or service development or more generally to 'investigate contemporary phenomena within its real-life context' [ 1 ]. Based on our experiences of conducting a range of case studies, we reflect on when to consider using this approach, discuss the key steps involved and illustrate, with examples, some of the practical challenges of attaining an in-depth understanding of a 'case' as an integrated whole. In keeping with previously published work, we acknowledge the importance of theory to underpin the design, selection, conduct and interpretation of case studies[ 2 ]. In so doing, we make passing reference to the different epistemological approaches used in case study research by key theoreticians and methodologists in this field of enquiry.

This paper is structured around the following main questions: What is a case study? What are case studies used for? How are case studies conducted? What are the potential pitfalls and how can these be avoided? We draw in particular on four of our own recently published examples of case studies (see Tables 1 , 2 , 3 and 4 ) and those of others to illustrate our discussion[ 3 – 7 ].

What is a case study?

A case study is a research approach that is used to generate an in-depth, multi-faceted understanding of a complex issue in its real-life context. It is an established research design that is used extensively in a wide variety of disciplines, particularly in the social sciences. A case study can be defined in a variety of ways (Table 5 ), the central tenet being the need to explore an event or phenomenon in depth and in its natural context. It is for this reason sometimes referred to as a "naturalistic" design; this is in contrast to an "experimental" design (such as a randomised controlled trial) in which the investigator seeks to exert control over and manipulate the variable(s) of interest.

Stake's work has been particularly influential in defining the case study approach to scientific enquiry. He has helpfully characterised three main types of case study: intrinsic , instrumental and collective [ 8 ]. An intrinsic case study is typically undertaken to learn about a unique phenomenon. The researcher should define the uniqueness of the phenomenon, which distinguishes it from all others. In contrast, the instrumental case study uses a particular case (some of which may be better than others) to gain a broader appreciation of an issue or phenomenon. The collective case study involves studying multiple cases simultaneously or sequentially in an attempt to generate a still broader appreciation of a particular issue.

These are however not necessarily mutually exclusive categories. In the first of our examples (Table 1 ), we undertook an intrinsic case study to investigate the issue of recruitment of minority ethnic people into the specific context of asthma research studies, but it developed into a instrumental case study through seeking to understand the issue of recruitment of these marginalised populations more generally, generating a number of the findings that are potentially transferable to other disease contexts[ 3 ]. In contrast, the other three examples (see Tables 2 , 3 and 4 ) employed collective case study designs to study the introduction of workforce reconfiguration in primary care, the implementation of electronic health records into hospitals, and to understand the ways in which healthcare students learn about patient safety considerations[ 4 – 6 ]. Although our study focusing on the introduction of General Practitioners with Specialist Interests (Table 2 ) was explicitly collective in design (four contrasting primary care organisations were studied), is was also instrumental in that this particular professional group was studied as an exemplar of the more general phenomenon of workforce redesign[ 4 ].

What are case studies used for?

According to Yin, case studies can be used to explain, describe or explore events or phenomena in the everyday contexts in which they occur[ 1 ]. These can, for example, help to understand and explain causal links and pathways resulting from a new policy initiative or service development (see Tables 2 and 3 , for example)[ 1 ]. In contrast to experimental designs, which seek to test a specific hypothesis through deliberately manipulating the environment (like, for example, in a randomised controlled trial giving a new drug to randomly selected individuals and then comparing outcomes with controls),[ 9 ] the case study approach lends itself well to capturing information on more explanatory ' how ', 'what' and ' why ' questions, such as ' how is the intervention being implemented and received on the ground?'. The case study approach can offer additional insights into what gaps exist in its delivery or why one implementation strategy might be chosen over another. This in turn can help develop or refine theory, as shown in our study of the teaching of patient safety in undergraduate curricula (Table 4 )[ 6 , 10 ]. Key questions to consider when selecting the most appropriate study design are whether it is desirable or indeed possible to undertake a formal experimental investigation in which individuals and/or organisations are allocated to an intervention or control arm? Or whether the wish is to obtain a more naturalistic understanding of an issue? The former is ideally studied using a controlled experimental design, whereas the latter is more appropriately studied using a case study design.

Case studies may be approached in different ways depending on the epistemological standpoint of the researcher, that is, whether they take a critical (questioning one's own and others' assumptions), interpretivist (trying to understand individual and shared social meanings) or positivist approach (orientating towards the criteria of natural sciences, such as focusing on generalisability considerations) (Table 6 ). Whilst such a schema can be conceptually helpful, it may be appropriate to draw on more than one approach in any case study, particularly in the context of conducting health services research. Doolin has, for example, noted that in the context of undertaking interpretative case studies, researchers can usefully draw on a critical, reflective perspective which seeks to take into account the wider social and political environment that has shaped the case[ 11 ].

How are case studies conducted?

Here, we focus on the main stages of research activity when planning and undertaking a case study; the crucial stages are: defining the case; selecting the case(s); collecting and analysing the data; interpreting data; and reporting the findings.

Defining the case

Carefully formulated research question(s), informed by the existing literature and a prior appreciation of the theoretical issues and setting(s), are all important in appropriately and succinctly defining the case[ 8 , 12 ]. Crucially, each case should have a pre-defined boundary which clarifies the nature and time period covered by the case study (i.e. its scope, beginning and end), the relevant social group, organisation or geographical area of interest to the investigator, the types of evidence to be collected, and the priorities for data collection and analysis (see Table 7 )[ 1 ]. A theory driven approach to defining the case may help generate knowledge that is potentially transferable to a range of clinical contexts and behaviours; using theory is also likely to result in a more informed appreciation of, for example, how and why interventions have succeeded or failed[ 13 ].

For example, in our evaluation of the introduction of electronic health records in English hospitals (Table 3 ), we defined our cases as the NHS Trusts that were receiving the new technology[ 5 ]. Our focus was on how the technology was being implemented. However, if the primary research interest had been on the social and organisational dimensions of implementation, we might have defined our case differently as a grouping of healthcare professionals (e.g. doctors and/or nurses). The precise beginning and end of the case may however prove difficult to define. Pursuing this same example, when does the process of implementation and adoption of an electronic health record system really begin or end? Such judgements will inevitably be influenced by a range of factors, including the research question, theory of interest, the scope and richness of the gathered data and the resources available to the research team.

Selecting the case(s)

The decision on how to select the case(s) to study is a very important one that merits some reflection. In an intrinsic case study, the case is selected on its own merits[ 8 ]. The case is selected not because it is representative of other cases, but because of its uniqueness, which is of genuine interest to the researchers. This was, for example, the case in our study of the recruitment of minority ethnic participants into asthma research (Table 1 ) as our earlier work had demonstrated the marginalisation of minority ethnic people with asthma, despite evidence of disproportionate asthma morbidity[ 14 , 15 ]. In another example of an intrinsic case study, Hellstrom et al.[ 16 ] studied an elderly married couple living with dementia to explore how dementia had impacted on their understanding of home, their everyday life and their relationships.

For an instrumental case study, selecting a "typical" case can work well[ 8 ]. In contrast to the intrinsic case study, the particular case which is chosen is of less importance than selecting a case that allows the researcher to investigate an issue or phenomenon. For example, in order to gain an understanding of doctors' responses to health policy initiatives, Som undertook an instrumental case study interviewing clinicians who had a range of responsibilities for clinical governance in one NHS acute hospital trust[ 17 ]. Sampling a "deviant" or "atypical" case may however prove even more informative, potentially enabling the researcher to identify causal processes, generate hypotheses and develop theory.

In collective or multiple case studies, a number of cases are carefully selected. This offers the advantage of allowing comparisons to be made across several cases and/or replication. Choosing a "typical" case may enable the findings to be generalised to theory (i.e. analytical generalisation) or to test theory by replicating the findings in a second or even a third case (i.e. replication logic)[ 1 ]. Yin suggests two or three literal replications (i.e. predicting similar results) if the theory is straightforward and five or more if the theory is more subtle. However, critics might argue that selecting 'cases' in this way is insufficiently reflexive and ill-suited to the complexities of contemporary healthcare organisations.

The selected case study site(s) should allow the research team access to the group of individuals, the organisation, the processes or whatever else constitutes the chosen unit of analysis for the study. Access is therefore a central consideration; the researcher needs to come to know the case study site(s) well and to work cooperatively with them. Selected cases need to be not only interesting but also hospitable to the inquiry [ 8 ] if they are to be informative and answer the research question(s). Case study sites may also be pre-selected for the researcher, with decisions being influenced by key stakeholders. For example, our selection of case study sites in the evaluation of the implementation and adoption of electronic health record systems (see Table 3 ) was heavily influenced by NHS Connecting for Health, the government agency that was responsible for overseeing the National Programme for Information Technology (NPfIT)[ 5 ]. This prominent stakeholder had already selected the NHS sites (through a competitive bidding process) to be early adopters of the electronic health record systems and had negotiated contracts that detailed the deployment timelines.

It is also important to consider in advance the likely burden and risks associated with participation for those who (or the site(s) which) comprise the case study. Of particular importance is the obligation for the researcher to think through the ethical implications of the study (e.g. the risk of inadvertently breaching anonymity or confidentiality) and to ensure that potential participants/participating sites are provided with sufficient information to make an informed choice about joining the study. The outcome of providing this information might be that the emotive burden associated with participation, or the organisational disruption associated with supporting the fieldwork, is considered so high that the individuals or sites decide against participation.

In our example of evaluating implementations of electronic health record systems, given the restricted number of early adopter sites available to us, we sought purposively to select a diverse range of implementation cases among those that were available[ 5 ]. We chose a mixture of teaching, non-teaching and Foundation Trust hospitals, and examples of each of the three electronic health record systems procured centrally by the NPfIT. At one recruited site, it quickly became apparent that access was problematic because of competing demands on that organisation. Recognising the importance of full access and co-operative working for generating rich data, the research team decided not to pursue work at that site and instead to focus on other recruited sites.

Collecting the data

In order to develop a thorough understanding of the case, the case study approach usually involves the collection of multiple sources of evidence, using a range of quantitative (e.g. questionnaires, audits and analysis of routinely collected healthcare data) and more commonly qualitative techniques (e.g. interviews, focus groups and observations). The use of multiple sources of data (data triangulation) has been advocated as a way of increasing the internal validity of a study (i.e. the extent to which the method is appropriate to answer the research question)[ 8 , 18 – 21 ]. An underlying assumption is that data collected in different ways should lead to similar conclusions, and approaching the same issue from different angles can help develop a holistic picture of the phenomenon (Table 2 )[ 4 ].

Brazier and colleagues used a mixed-methods case study approach to investigate the impact of a cancer care programme[ 22 ]. Here, quantitative measures were collected with questionnaires before, and five months after, the start of the intervention which did not yield any statistically significant results. Qualitative interviews with patients however helped provide an insight into potentially beneficial process-related aspects of the programme, such as greater, perceived patient involvement in care. The authors reported how this case study approach provided a number of contextual factors likely to influence the effectiveness of the intervention and which were not likely to have been obtained from quantitative methods alone.

In collective or multiple case studies, data collection needs to be flexible enough to allow a detailed description of each individual case to be developed (e.g. the nature of different cancer care programmes), before considering the emerging similarities and differences in cross-case comparisons (e.g. to explore why one programme is more effective than another). It is important that data sources from different cases are, where possible, broadly comparable for this purpose even though they may vary in nature and depth.

Analysing, interpreting and reporting case studies

Making sense and offering a coherent interpretation of the typically disparate sources of data (whether qualitative alone or together with quantitative) is far from straightforward. Repeated reviewing and sorting of the voluminous and detail-rich data are integral to the process of analysis. In collective case studies, it is helpful to analyse data relating to the individual component cases first, before making comparisons across cases. Attention needs to be paid to variations within each case and, where relevant, the relationship between different causes, effects and outcomes[ 23 ]. Data will need to be organised and coded to allow the key issues, both derived from the literature and emerging from the dataset, to be easily retrieved at a later stage. An initial coding frame can help capture these issues and can be applied systematically to the whole dataset with the aid of a qualitative data analysis software package.

The Framework approach is a practical approach, comprising of five stages (familiarisation; identifying a thematic framework; indexing; charting; mapping and interpretation) , to managing and analysing large datasets particularly if time is limited, as was the case in our study of recruitment of South Asians into asthma research (Table 1 )[ 3 , 24 ]. Theoretical frameworks may also play an important role in integrating different sources of data and examining emerging themes. For example, we drew on a socio-technical framework to help explain the connections between different elements - technology; people; and the organisational settings within which they worked - in our study of the introduction of electronic health record systems (Table 3 )[ 5 ]. Our study of patient safety in undergraduate curricula drew on an evaluation-based approach to design and analysis, which emphasised the importance of the academic, organisational and practice contexts through which students learn (Table 4 )[ 6 ].

Case study findings can have implications both for theory development and theory testing. They may establish, strengthen or weaken historical explanations of a case and, in certain circumstances, allow theoretical (as opposed to statistical) generalisation beyond the particular cases studied[ 12 ]. These theoretical lenses should not, however, constitute a strait-jacket and the cases should not be "forced to fit" the particular theoretical framework that is being employed.

When reporting findings, it is important to provide the reader with enough contextual information to understand the processes that were followed and how the conclusions were reached. In a collective case study, researchers may choose to present the findings from individual cases separately before amalgamating across cases. Care must be taken to ensure the anonymity of both case sites and individual participants (if agreed in advance) by allocating appropriate codes or withholding descriptors. In the example given in Table 3 , we decided against providing detailed information on the NHS sites and individual participants in order to avoid the risk of inadvertent disclosure of identities[ 5 , 25 ].

What are the potential pitfalls and how can these be avoided?

The case study approach is, as with all research, not without its limitations. When investigating the formal and informal ways undergraduate students learn about patient safety (Table 4 ), for example, we rapidly accumulated a large quantity of data. The volume of data, together with the time restrictions in place, impacted on the depth of analysis that was possible within the available resources. This highlights a more general point of the importance of avoiding the temptation to collect as much data as possible; adequate time also needs to be set aside for data analysis and interpretation of what are often highly complex datasets.

Case study research has sometimes been criticised for lacking scientific rigour and providing little basis for generalisation (i.e. producing findings that may be transferable to other settings)[ 1 ]. There are several ways to address these concerns, including: the use of theoretical sampling (i.e. drawing on a particular conceptual framework); respondent validation (i.e. participants checking emerging findings and the researcher's interpretation, and providing an opinion as to whether they feel these are accurate); and transparency throughout the research process (see Table 8 )[ 8 , 18 – 21 , 23 , 26 ]. Transparency can be achieved by describing in detail the steps involved in case selection, data collection, the reasons for the particular methods chosen, and the researcher's background and level of involvement (i.e. being explicit about how the researcher has influenced data collection and interpretation). Seeking potential, alternative explanations, and being explicit about how interpretations and conclusions were reached, help readers to judge the trustworthiness of the case study report. Stake provides a critique checklist for a case study report (Table 9 )[ 8 ].

Conclusions

The case study approach allows, amongst other things, critical events, interventions, policy developments and programme-based service reforms to be studied in detail in a real-life context. It should therefore be considered when an experimental design is either inappropriate to answer the research questions posed or impossible to undertake. Considering the frequency with which implementations of innovations are now taking place in healthcare settings and how well the case study approach lends itself to in-depth, complex health service research, we believe this approach should be more widely considered by researchers. Though inherently challenging, the research case study can, if carefully conceptualised and thoughtfully undertaken and reported, yield powerful insights into many important aspects of health and healthcare delivery.

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Acknowledgements

We are grateful to the participants and colleagues who contributed to the individual case studies that we have drawn on. This work received no direct funding, but it has been informed by projects funded by Asthma UK, the NHS Service Delivery Organisation, NHS Connecting for Health Evaluation Programme, and Patient Safety Research Portfolio. We would also like to thank the expert reviewers for their insightful and constructive feedback. Our thanks are also due to Dr. Allison Worth who commented on an earlier draft of this manuscript.

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AS conceived this article. SC, KC and AR wrote this paper with GH, AA and AS all commenting on various drafts. SC and AS are guarantors.

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Crowe, S., Cresswell, K., Robertson, A. et al. The case study approach. BMC Med Res Methodol 11 , 100 (2011). https://doi.org/10.1186/1471-2288-11-100

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Case Study Research Method in Psychology

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Case studies are in-depth investigations of a person, group, event, or community. Typically, data is gathered from various sources using several methods (e.g., observations & interviews).

The case study research method originated in clinical medicine (the case history, i.e., the patient’s personal history). In psychology, case studies are often confined to the study of a particular individual.

The information is mainly biographical and relates to events in the individual’s past (i.e., retrospective), as well as to significant events that are currently occurring in his or her everyday life.

The case study is not a research method, but researchers select methods of data collection and analysis that will generate material suitable for case studies.

Freud (1909a, 1909b) conducted very detailed investigations into the private lives of his patients in an attempt to both understand and help them overcome their illnesses.

This makes it clear that the case study is a method that should only be used by a psychologist, therapist, or psychiatrist, i.e., someone with a professional qualification.

There is an ethical issue of competence. Only someone qualified to diagnose and treat a person can conduct a formal case study relating to atypical (i.e., abnormal) behavior or atypical development.

Famous Case Studies

Anna O – One of the most famous case studies, documenting psychoanalyst Josef Breuer’s treatment of “Anna O” (real name Bertha Pappenheim) for hysteria in the late 1800s using early psychoanalytic theory.
Little Hans – A child psychoanalysis case study published by Sigmund Freud in 1909 analyzing his five-year-old patient Herbert Graf’s house phobia as related to the Oedipus complex.
Bruce/Brenda – Gender identity case of the boy (Bruce) whose botched circumcision led psychologist John Money to advise gender reassignment and raise him as a girl (Brenda) in the 1960s.
Genie Wiley – Linguistics/psychological development case of the victim of extreme isolation abuse who was studied in 1970s California for effects of early language deprivation on acquiring speech later in life.
Phineas Gage – One of the most famous neuropsychology case studies analyzes personality changes in railroad worker Phineas Gage after an 1848 brain injury involving a tamping iron piercing his skull.

Clinical Case Studies

Studying the effectiveness of psychotherapy approaches with an individual patient
Assessing and treating mental illnesses like depression, anxiety disorders, PTSD
Neuropsychological cases investigating brain injuries or disorders

Child Psychology Case Studies

Studying psychological development from birth through adolescence
Cases of learning disabilities, autism spectrum disorders, ADHD
Effects of trauma, abuse, deprivation on development

Types of Case Studies

Explanatory case studies : Used to explore causation in order to find underlying principles. Helpful for doing qualitative analysis to explain presumed causal links.
Exploratory case studies : Used to explore situations where an intervention being evaluated has no clear set of outcomes. It helps define questions and hypotheses for future research.
Descriptive case studies : Describe an intervention or phenomenon and the real-life context in which it occurred. It is helpful for illustrating certain topics within an evaluation.
Multiple-case studies : Used to explore differences between cases and replicate findings across cases. Helpful for comparing and contrasting specific cases.
Intrinsic : Used to gain a better understanding of a particular case. Helpful for capturing the complexity of a single case.
Collective : Used to explore a general phenomenon using multiple case studies. Helpful for jointly studying a group of cases in order to inquire into the phenomenon.

Where Do You Find Data for a Case Study?

There are several places to find data for a case study. The key is to gather data from multiple sources to get a complete picture of the case and corroborate facts or findings through triangulation of evidence. Most of this information is likely qualitative (i.e., verbal description rather than measurement), but the psychologist might also collect numerical data.

1. Primary sources

Interviews – Interviewing key people related to the case to get their perspectives and insights. The interview is an extremely effective procedure for obtaining information about an individual, and it may be used to collect comments from the person’s friends, parents, employer, workmates, and others who have a good knowledge of the person, as well as to obtain facts from the person him or herself.
Observations – Observing behaviors, interactions, processes, etc., related to the case as they unfold in real-time.
Documents & Records – Reviewing private documents, diaries, public records, correspondence, meeting minutes, etc., relevant to the case.

2. Secondary sources

News/Media – News coverage of events related to the case study.
Academic articles – Journal articles, dissertations etc. that discuss the case.
Government reports – Official data and records related to the case context.
Books/films – Books, documentaries or films discussing the case.

3. Archival records

Searching historical archives, museum collections and databases to find relevant documents, visual/audio records related to the case history and context.

Public archives like newspapers, organizational records, photographic collections could all include potentially relevant pieces of information to shed light on attitudes, cultural perspectives, common practices and historical contexts related to psychology.

4. Organizational records

Organizational records offer the advantage of often having large datasets collected over time that can reveal or confirm psychological insights.

Of course, privacy and ethical concerns regarding confidential data must be navigated carefully.

However, with proper protocols, organizational records can provide invaluable context and empirical depth to qualitative case studies exploring the intersection of psychology and organizations.

Organizational/industrial psychology research : Organizational records like employee surveys, turnover/retention data, policies, incident reports etc. may provide insight into topics like job satisfaction, workplace culture and dynamics, leadership issues, employee behaviors etc.
Clinical psychology : Therapists/hospitals may grant access to anonymized medical records to study aspects like assessments, diagnoses, treatment plans etc. This could shed light on clinical practices.
School psychology : Studies could utilize anonymized student records like test scores, grades, disciplinary issues, and counseling referrals to study child development, learning barriers, effectiveness of support programs, and more.

How do I Write a Case Study in Psychology?

Follow specified case study guidelines provided by a journal or your psychology tutor. General components of clinical case studies include: background, symptoms, assessments, diagnosis, treatment, and outcomes. Interpreting the information means the researcher decides what to include or leave out. A good case study should always clarify which information is the factual description and which is an inference or the researcher’s opinion.

1. Introduction

Provide background on the case context and why it is of interest, presenting background information like demographics, relevant history, and presenting problem.
Compare briefly to similar published cases if applicable. Clearly state the focus/importance of the case.

2. Case Presentation

Describe the presenting problem in detail, including symptoms, duration,and impact on daily life.
Include client demographics like age and gender, information about social relationships, and mental health history.
Describe all physical, emotional, and/or sensory symptoms reported by the client.
Use patient quotes to describe the initial complaint verbatim. Follow with full-sentence summaries of relevant history details gathered, including key components that led to a working diagnosis.
Summarize clinical exam results, namely orthopedic/neurological tests, imaging, lab tests, etc. Note actual results rather than subjective conclusions. Provide images if clearly reproducible/anonymized.
Clearly state the working diagnosis or clinical impression before transitioning to management.

3. Management and Outcome

Indicate the total duration of care and number of treatments given over what timeframe. Use specific names/descriptions for any therapies/interventions applied.
Present the results of the intervention,including any quantitative or qualitative data collected.
For outcomes, utilize visual analog scales for pain, medication usage logs, etc., if possible. Include patient self-reports of improvement/worsening of symptoms. Note the reason for discharge/end of care.

4. Discussion

Analyze the case, exploring contributing factors, limitations of the study, and connections to existing research.
Analyze the effectiveness of the intervention,considering factors like participant adherence, limitations of the study, and potential alternative explanations for the results.
Identify any questions raised in the case analysis and relate insights to established theories and current research if applicable. Avoid definitive claims about physiological explanations.
Offer clinical implications, and suggest future research directions.

5. Additional Items

Thank specific assistants for writing support only. No patient acknowledgments.
References should directly support any key claims or quotes included.
Use tables/figures/images only if substantially informative. Include permissions and legends/explanatory notes.
Provides detailed (rich qualitative) information.
Provides insight for further research.
Permitting investigation of otherwise impractical (or unethical) situations.

Case studies allow a researcher to investigate a topic in far more detail than might be possible if they were trying to deal with a large number of research participants (nomothetic approach) with the aim of ‘averaging’.

Because of their in-depth, multi-sided approach, case studies often shed light on aspects of human thinking and behavior that would be unethical or impractical to study in other ways.

Research that only looks into the measurable aspects of human behavior is not likely to give us insights into the subjective dimension of experience, which is important to psychoanalytic and humanistic psychologists.

Case studies are often used in exploratory research. They can help us generate new ideas (that might be tested by other methods). They are an important way of illustrating theories and can help show how different aspects of a person’s life are related to each other.

The method is, therefore, important for psychologists who adopt a holistic point of view (i.e., humanistic psychologists ).

Limitations

Lacking scientific rigor and providing little basis for generalization of results to the wider population.
Researchers’ own subjective feelings may influence the case study (researcher bias).
Difficult to replicate.
Time-consuming and expensive.
The volume of data, together with the time restrictions in place, impacted the depth of analysis that was possible within the available resources.

Because a case study deals with only one person/event/group, we can never be sure if the case study investigated is representative of the wider body of “similar” instances. This means the conclusions drawn from a particular case may not be transferable to other settings.

Because case studies are based on the analysis of qualitative (i.e., descriptive) data , a lot depends on the psychologist’s interpretation of the information she has acquired.

This means that there is a lot of scope for Anna O , and it could be that the subjective opinions of the psychologist intrude in the assessment of what the data means.

For example, Freud has been criticized for producing case studies in which the information was sometimes distorted to fit particular behavioral theories (e.g., Little Hans ).

This is also true of Money’s interpretation of the Bruce/Brenda case study (Diamond, 1997) when he ignored evidence that went against his theory.

Breuer, J., & Freud, S. (1895). Studies on hysteria . Standard Edition 2: London.

Curtiss, S. (1981). Genie: The case of a modern wild child .

Diamond, M., & Sigmundson, K. (1997). Sex Reassignment at Birth: Long-term Review and Clinical Implications. Archives of Pediatrics & Adolescent Medicine , 151(3), 298-304

Freud, S. (1909a). Analysis of a phobia of a five year old boy. In The Pelican Freud Library (1977), Vol 8, Case Histories 1, pages 169-306

Freud, S. (1909b). Bemerkungen über einen Fall von Zwangsneurose (Der “Rattenmann”). Jb. psychoanal. psychopathol. Forsch ., I, p. 357-421; GW, VII, p. 379-463; Notes upon a case of obsessional neurosis, SE , 10: 151-318.

Harlow J. M. (1848). Passage of an iron rod through the head. Boston Medical and Surgical Journal, 39 , 389–393.

Harlow, J. M. (1868). Recovery from the Passage of an Iron Bar through the Head . Publications of the Massachusetts Medical Society. 2 (3), 327-347.

Money, J., & Ehrhardt, A. A. (1972). Man & Woman, Boy & Girl : The Differentiation and Dimorphism of Gender Identity from Conception to Maturity. Baltimore, Maryland: Johns Hopkins University Press.

Money, J., & Tucker, P. (1975). Sexual signatures: On being a man or a woman.

Further Information

Case Study Approach
Case Study Method
Enhancing the Quality of Case Studies in Health Services Research
“We do things together” A case study of “couplehood” in dementia
Using mixed methods for evaluating an integrative approach to cancer care: a case study

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28 Nov 2023

While several factors make HBS Online unique —including a global Community and real-world outcomes —active learning through the case study method rises to the top.

In a 2023 City Square Associates survey, 74 percent of HBS Online learners who also took a course from another provider said HBS Online’s case method and real-world examples were better by comparison.

Here’s a primer on the case method, five benefits you could gain, and how to experience it for yourself.

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What Is the Harvard Business School Case Study Method?

The case study method , or case method , is a learning technique in which you’re presented with a real-world business challenge and asked how you’d solve it. After working through it yourself and with peers, you’re told how the scenario played out.

HBS pioneered the case method in 1922. Shortly before, in 1921, the first case was written.

“How do you go into an ambiguous situation and get to the bottom of it?” says HBS Professor Jan Rivkin, former senior associate dean and chair of HBS's master of business administration (MBA) program, in a video about the case method . “That skill—the skill of figuring out a course of inquiry to choose a course of action—that skill is as relevant today as it was in 1921.”

Originally developed for the in-person MBA classroom, HBS Online adapted the case method into an engaging, interactive online learning experience in 2014.

In HBS Online courses , you learn about each case from the business professional who experienced it. After reviewing their videos, you’re prompted to take their perspective and explain how you’d handle their situation.

You then get to read peers’ responses, “star” them, and comment to further the discussion. Afterward, you learn how the professional handled it and their key takeaways.

Learn more about HBS Online's approach to the case method in the video below, and subscribe to our YouTube channel for more.

HBS Online’s adaptation of the case method incorporates the famed HBS “cold call,” in which you’re called on at random to make a decision without time to prepare.

“Learning came to life!” said Sheneka Balogun , chief administration officer and chief of staff at LeMoyne-Owen College, of her experience taking the Credential of Readiness (CORe) program . “The videos from the professors, the interactive cold calls where you were randomly selected to participate, and the case studies that enhanced and often captured the essence of objectives and learning goals were all embedded in each module. This made learning fun, engaging, and student-friendly.”

If you’re considering taking a course that leverages the case study method, here are five benefits you could experience.

5 Benefits of Learning Through Case Studies

1. take new perspectives.

The case method prompts you to consider a scenario from another person’s perspective. To work through the situation and come up with a solution, you must consider their circumstances, limitations, risk tolerance, stakeholders, resources, and potential consequences to assess how to respond.

Taking on new perspectives not only can help you navigate your own challenges but also others’. Putting yourself in someone else’s situation to understand their motivations and needs can go a long way when collaborating with stakeholders.

2. Hone Your Decision-Making Skills

Another skill you can build is the ability to make decisions effectively . The case study method forces you to use limited information to decide how to handle a problem—just like in the real world.

Throughout your career, you’ll need to make difficult decisions with incomplete or imperfect information—and sometimes, you won’t feel qualified to do so. Learning through the case method allows you to practice this skill in a low-stakes environment. When facing a real challenge, you’ll be better prepared to think quickly, collaborate with others, and present and defend your solution.

3. Become More Open-Minded

As you collaborate with peers on responses, it becomes clear that not everyone solves problems the same way. Exposing yourself to various approaches and perspectives can help you become a more open-minded professional.

When you’re part of a diverse group of learners from around the world, your experiences, cultures, and backgrounds contribute to a range of opinions on each case.

On the HBS Online course platform, you’re prompted to view and comment on others’ responses, and discussion is encouraged. This practice of considering others’ perspectives can make you more receptive in your career.

“You’d be surprised at how much you can learn from your peers,” said Ratnaditya Jonnalagadda , a software engineer who took CORe.

In addition to interacting with peers in the course platform, Jonnalagadda was part of the HBS Online Community , where he networked with other professionals and continued discussions sparked by course content.

“You get to understand your peers better, and students share examples of businesses implementing a concept from a module you just learned,” Jonnalagadda said. “It’s a very good way to cement the concepts in one's mind.”

4. Enhance Your Curiosity

One byproduct of taking on different perspectives is that it enables you to picture yourself in various roles, industries, and business functions.

“Each case offers an opportunity for students to see what resonates with them, what excites them, what bores them, which role they could imagine inhabiting in their careers,” says former HBS Dean Nitin Nohria in the Harvard Business Review . “Cases stimulate curiosity about the range of opportunities in the world and the many ways that students can make a difference as leaders.”

Through the case method, you can “try on” roles you may not have considered and feel more prepared to change or advance your career .

5. Build Your Self-Confidence

Finally, learning through the case study method can build your confidence. Each time you assume a business leader’s perspective, aim to solve a new challenge, and express and defend your opinions and decisions to peers, you prepare to do the same in your career.

According to a 2022 City Square Associates survey , 84 percent of HBS Online learners report feeling more confident making business decisions after taking a course.

“Self-confidence is difficult to teach or coach, but the case study method seems to instill it in people,” Nohria says in the Harvard Business Review . “There may well be other ways of learning these meta-skills, such as the repeated experience gained through practice or guidance from a gifted coach. However, under the direction of a masterful teacher, the case method can engage students and help them develop powerful meta-skills like no other form of teaching.”

Your Guide to Online Learning Success | Download Your Free E-Book

How to Experience the Case Study Method

If the case method seems like a good fit for your learning style, experience it for yourself by taking an HBS Online course. Offerings span eight subject areas, including:

Business essentials
Leadership and management
Entrepreneurship and innovation
Digital transformation
Finance and accounting
Business in society

No matter which course or credential program you choose, you’ll examine case studies from real business professionals, work through their challenges alongside peers, and gain valuable insights to apply to your career.

Are you interested in discovering how HBS Online can help advance your career? Explore our course catalog and download our free guide —complete with interactive workbook sections—to determine if online learning is right for you and which course to take.

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What the Case Study Method Really Teaches

Nitin Nohria

Seven meta-skills that stick even if the cases fade from memory.

It’s been 100 years since Harvard Business School began using the case study method. Beyond teaching specific subject matter, the case study method excels in instilling meta-skills in students. This article explains the importance of seven such skills: preparation, discernment, bias recognition, judgement, collaboration, curiosity, and self-confidence.

During my decade as dean of Harvard Business School, I spent hundreds of hours talking with our alumni. To enliven these conversations, I relied on a favorite question: “What was the most important thing you learned from your time in our MBA program?”

Nitin Nohria is the George F. Baker Jr. and Distinguished Service University Professor. He served as the 10th dean of Harvard Business School, from 2010 to 2020.

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Introduction

The case study creation process

Types of case studies, benefits and limitations.

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Table Of Contents

case study , detailed description and assessment of a specific situation in the real world created for the purpose of deriving generalizations and other insights from it. A case study can be about an individual, a group of people, an organization, or an event, among other subjects.

By focusing on a specific subject in its natural setting, a case study can help improve understanding of the broader features and processes at work. Case studies are a research method used in multiple fields, including business, criminology , education , medicine and other forms of health care, anthropology , political science , psychology , and social work . Data in case studies can be both qualitative and quantitative. Unlike experiments, where researchers control and manipulate situations, case studies are considered to be “naturalistic” because subjects are studied in their natural context . ( See also natural experiment .)

The creation of a case study typically involves the following steps:

The research question to be studied is defined, informed by existing literature and previous research. Researchers should clearly define the scope of the case, and they should compile a list of evidence to be collected as well as identify the nature of insights that they expect to gain from the case study.
Once the case is identified, the research team is given access to the individual, organization, or situation being studied. Individuals are informed of risks associated with participation and must provide their consent , which may involve signing confidentiality or anonymity agreements.
Researchers then collect evidence using multiple methods, which may include qualitative techniques, such as interviews, focus groups , and direct observations, as well as quantitative methods, such as surveys, questionnaires, and data audits. The collection procedures need to be well defined to ensure the relevance and accuracy of the evidence.
The collected evidence is analyzed to come up with insights. Each data source must be reviewed carefully by itself and in the larger context of the case study so as to ensure continued relevance. At the same time, care must be taken not to force the analysis to fit (potentially preconceived) conclusions. While the eventual case study may serve as the basis for generalizations, these generalizations must be made cautiously to ensure that specific nuances are not lost in the averages.
Finally, the case study is packaged for larger groups and publication. At this stage some information may be withheld, as in business case studies, to allow readers to draw their own conclusions. In scientific fields, the completed case study needs to be a coherent whole, with all findings and statistical relationships clearly documented.

Case studies have been used as a research method across multiple fields. They are particularly popular in the fields of law, business, and employee training; they typically focus on a problem that an individual or organization is facing. The situation is presented in considerable detail, often with supporting data, to discussion participants, who are asked to make recommendations that will solve the stated problem. The business case study as a method of instruction was made popular in the 1920s by instructors at Harvard Business School who adapted an approach used at Harvard Law School in which real-world cases were used in classroom discussions. Other business and law schools started compiling case studies as teaching aids for students. In a business school case study, students are not provided with the complete list of facts pertaining to the topic and are thus forced to discuss and compare their perspectives with those of their peers to recommend solutions.

In criminology , case studies typically focus on the lives of an individual or a group of individuals. These studies can provide particularly valuable insight into the personalities and motives of individual criminals, but they may suffer from a lack of objectivity on the part of the researchers (typically because of the researchers’ biases when working with people with a criminal history), and their findings may be difficult to generalize.

In sociology , the case-study method was developed by Frédéric Le Play in France during the 19th century. This approach involves a field worker staying with a family for a period of time, gathering data on the family members’ attitudes and interactions and on their income, expenditures, and physical possessions. Similar approaches have been used in anthropology . Such studies can sometimes continue for many years.

Case studies provide insight into situations that involve a specific entity or set of circumstances. They can be beneficial in helping to explain the causal relationships between quantitative indicators in a field of study, such as what drives a company’s market share. By introducing real-world examples, they also plunge the reader into an actual, concrete situation and make the concepts real rather than theoretical. They also help people study rare situations that they might not otherwise experience.

Because case studies are in a “naturalistic” environment , they are limited in terms of research design: researchers lack control over what they are studying, which means that the results often cannot be reproduced. Also, care must be taken to stay within the bounds of the research question on which the case study is focusing. Other limitations to case studies revolve around the data collected. It may be difficult, for instance, for researchers to organize the large volume of data that can emerge from the study, and their analysis of the data must be carefully thought through to produce scientifically valid insights. The research methodology used to generate these insights is as important as the insights themselves, for the latter need to be seen in the proper context. Taken out of context, they may lead to erroneous conclusions. Like all scientific studies, case studies need to be approached objectively; personal bias or opinion may skew the research methods as well as the results. ( See also confirmation bias .)

Business case studies in particular have been criticized for approaching a problem or situation from a narrow perspective. Students are expected to come up with solutions for a problem based on the data provided. However, in real life, the situation is typically reversed: business managers face a problem and must then look for data to help them solve it.

What is the Case Study Method?

Simply put, the case method is a discussion of real-life situations that business executives have faced.

On average, you'll attend three to four different classes a day, for a total of about six hours of class time (schedules vary). To prepare, you'll work through problems with your peers.

How the Case Method Creates Value

Often, executives are surprised to discover that the objective of the case study is not to reach consensus, but to understand how different people use the same information to arrive at diverse conclusions. When you begin to understand the context, you can appreciate the reasons why those decisions were made. You can prepare for case discussions in several ways.

Case Discussion Preparation Details

In self-reflection.

The time you spend here is deeply introspective. You're not only working with case materials and assignments, but also taking on the role of the case protagonist—the person who's supposed to make those tough decisions. How would you react in those situations? We put people in a variety of contexts, and they start by addressing that specific problem.

In a small group setting

The discussion group is a critical component of the HBS experience. You're working in close quarters with a group of seven or eight very accomplished peers in diverse functions, industries, and geographies. Because they bring unique experience to play you begin to see that there are many different ways to wrestle with a problem—and that’s very enriching.

In the classroom

The faculty guides you in examining and resolving the issues—but the beauty here is that they don't provide you with the answers. You're interacting in the classroom with other executives—debating the issue, presenting new viewpoints, countering positions, and building on one another's ideas. And that leads to the next stage of learning.

Beyond the classroom

Once you leave the classroom, the learning continues and amplifies as you get to know people in different settings—over meals, at social gatherings, in the fitness center, or as you are walking to class. You begin to distill the takeaways that you want to bring back and apply in your organization to ensure that the decisions you make will create more value for your firm.

How Cases Unfold In the Classroom

Pioneered by HBS faculty, the case method puts you in the role of the chief decision maker as you explore the challenges facing leading companies across the globe. Learning to think fast on your feet with limited information sharpens your analytical skills and empowers you to make critical decisions in real time.

To get the most out of each case, it's important to read and reflect, and then meet with your discussion group to share your insights. You and your peers will explore the underlying issues, compare alternatives, and suggest various ways of resolving the problem.

How to Prepare for Case Discussions

There's more than one way to prepare for a case discussion, but these general guidelines can help you develop a method that works for you.

Preparation Guidelines

Read the professor's assignment or discussion questions.

The assignment and discussion questions help you focus on the key aspects of the case. Ask yourself: What are the most important issues being raised?

Read the first few paragraphs and then skim the case

Each case begins with a text description followed by exhibits. Ask yourself: What is the case generally about, and what information do I need to analyze?

Reread the case, underline text, and make margin notes

Put yourself in the shoes of the case protagonist, and own that person's problems. Ask yourself: What basic problem is this executive trying to resolve?

Note the key problems on a pad of paper and go through the case again

Sort out relevant considerations and do the quantitative or qualitative analysis. Ask yourself: What recommendations should I make based on my case data analysis?

Case Study Best Practices

The key to being an active listener and participant in case discussions—and to getting the most out of the learning experience—is thorough individual preparation.

We've set aside formal time for you to discuss the case with your group. These sessions will help you to become more confident about sharing your views in the classroom discussion.

Participate

Actively express your views and challenge others. Don't be afraid to share related "war stories" that will heighten the relevance and enrich the discussion.

If the content doesn't seem to relate to your business, don't tune out. You can learn a lot about marketing insurance from a case on marketing razor blades!

Actively apply what you're learning to your own specific management situations, both past and future. This will magnify the relevance to your business.

People with diverse backgrounds, experiences, skills, and styles will take away different things. Be sure to note what resonates with you, not your peers.

Being exposed to so many different approaches to a given situation will put you in a better position to enhance your management style.

Frequently Asked Questions

What can i expect on the first day, what happens in class if nobody talks, does everyone take part in "role-playing".

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What Is a Case Study?

Weighing the pros and cons of this method of research

Verywell / Colleen Tighe

Pros and Cons

What Types of Case Studies Are Out There?

Where do you find data for a case study, how do i write a psychology case study.

A case study is an in-depth study of one person, group, or event. In a case study, nearly every aspect of the subject's life and history is analyzed to seek patterns and causes of behavior. Case studies can be used in many different fields, including psychology, medicine, education, anthropology, political science, and social work.

The point of a case study is to learn as much as possible about an individual or group so that the information can be generalized to many others. Unfortunately, case studies tend to be highly subjective, and it is sometimes difficult to generalize results to a larger population.

While case studies focus on a single individual or group, they follow a format similar to other types of psychology writing. If you are writing a case study, we got you—here are some rules of APA format to reference.

At a Glance

A case study, or an in-depth study of a person, group, or event, can be a useful research tool when used wisely. In many cases, case studies are best used in situations where it would be difficult or impossible for you to conduct an experiment. They are helpful for looking at unique situations and allow researchers to gather a lot of˜ information about a specific individual or group of people. However, it's important to be cautious of any bias we draw from them as they are highly subjective.

What Are the Benefits and Limitations of Case Studies?

A case study can have its strengths and weaknesses. Researchers must consider these pros and cons before deciding if this type of study is appropriate for their needs.

One of the greatest advantages of a case study is that it allows researchers to investigate things that are often difficult or impossible to replicate in a lab. Some other benefits of a case study:

Allows researchers to capture information on the 'how,' 'what,' and 'why,' of something that's implemented
Gives researchers the chance to collect information on why one strategy might be chosen over another
Permits researchers to develop hypotheses that can be explored in experimental research

On the other hand, a case study can have some drawbacks:

It cannot necessarily be generalized to the larger population
Cannot demonstrate cause and effect
It may not be scientifically rigorous
It can lead to bias

Researchers may choose to perform a case study if they want to explore a unique or recently discovered phenomenon. Through their insights, researchers develop additional ideas and study questions that might be explored in future studies.

It's important to remember that the insights from case studies cannot be used to determine cause-and-effect relationships between variables. However, case studies may be used to develop hypotheses that can then be addressed in experimental research.

Case Study Examples

There have been a number of notable case studies in the history of psychology. Much of Freud's work and theories were developed through individual case studies. Some great examples of case studies in psychology include:

Anna O : Anna O. was a pseudonym of a woman named Bertha Pappenheim, a patient of a physician named Josef Breuer. While she was never a patient of Freud's, Freud and Breuer discussed her case extensively. The woman was experiencing symptoms of a condition that was then known as hysteria and found that talking about her problems helped relieve her symptoms. Her case played an important part in the development of talk therapy as an approach to mental health treatment.
Phineas Gage : Phineas Gage was a railroad employee who experienced a terrible accident in which an explosion sent a metal rod through his skull, damaging important portions of his brain. Gage recovered from his accident but was left with serious changes in both personality and behavior.
Genie : Genie was a young girl subjected to horrific abuse and isolation. The case study of Genie allowed researchers to study whether language learning was possible, even after missing critical periods for language development. Her case also served as an example of how scientific research may interfere with treatment and lead to further abuse of vulnerable individuals.

Such cases demonstrate how case research can be used to study things that researchers could not replicate in experimental settings. In Genie's case, her horrific abuse denied her the opportunity to learn a language at critical points in her development.

This is clearly not something researchers could ethically replicate, but conducting a case study on Genie allowed researchers to study phenomena that are otherwise impossible to reproduce.

There are a few different types of case studies that psychologists and other researchers might use:

Collective case studies : These involve studying a group of individuals. Researchers might study a group of people in a certain setting or look at an entire community. For example, psychologists might explore how access to resources in a community has affected the collective mental well-being of those who live there.
Descriptive case studies : These involve starting with a descriptive theory. The subjects are then observed, and the information gathered is compared to the pre-existing theory.
Explanatory case studies : These are often used to do causal investigations. In other words, researchers are interested in looking at factors that may have caused certain things to occur.
Exploratory case studies : These are sometimes used as a prelude to further, more in-depth research. This allows researchers to gather more information before developing their research questions and hypotheses .
Instrumental case studies : These occur when the individual or group allows researchers to understand more than what is initially obvious to observers.
Intrinsic case studies : This type of case study is when the researcher has a personal interest in the case. Jean Piaget's observations of his own children are good examples of how an intrinsic case study can contribute to the development of a psychological theory.

The three main case study types often used are intrinsic, instrumental, and collective. Intrinsic case studies are useful for learning about unique cases. Instrumental case studies help look at an individual to learn more about a broader issue. A collective case study can be useful for looking at several cases simultaneously.

The type of case study that psychology researchers use depends on the unique characteristics of the situation and the case itself.

There are a number of different sources and methods that researchers can use to gather information about an individual or group. Six major sources that have been identified by researchers are:

Archival records : Census records, survey records, and name lists are examples of archival records.
Direct observation : This strategy involves observing the subject, often in a natural setting . While an individual observer is sometimes used, it is more common to utilize a group of observers.
Documents : Letters, newspaper articles, administrative records, etc., are the types of documents often used as sources.
Interviews : Interviews are one of the most important methods for gathering information in case studies. An interview can involve structured survey questions or more open-ended questions.
Participant observation : When the researcher serves as a participant in events and observes the actions and outcomes, it is called participant observation.
Physical artifacts : Tools, objects, instruments, and other artifacts are often observed during a direct observation of the subject.

If you have been directed to write a case study for a psychology course, be sure to check with your instructor for any specific guidelines you need to follow. If you are writing your case study for a professional publication, check with the publisher for their specific guidelines for submitting a case study.

Here is a general outline of what should be included in a case study.

Section 1: A Case History

This section will have the following structure and content:

Background information : The first section of your paper will present your client's background. Include factors such as age, gender, work, health status, family mental health history, family and social relationships, drug and alcohol history, life difficulties, goals, and coping skills and weaknesses.

Description of the presenting problem : In the next section of your case study, you will describe the problem or symptoms that the client presented with.

Describe any physical, emotional, or sensory symptoms reported by the client. Thoughts, feelings, and perceptions related to the symptoms should also be noted. Any screening or diagnostic assessments that are used should also be described in detail and all scores reported.

Your diagnosis : Provide your diagnosis and give the appropriate Diagnostic and Statistical Manual code. Explain how you reached your diagnosis, how the client's symptoms fit the diagnostic criteria for the disorder(s), or any possible difficulties in reaching a diagnosis.

Section 2: Treatment Plan

This portion of the paper will address the chosen treatment for the condition. This might also include the theoretical basis for the chosen treatment or any other evidence that might exist to support why this approach was chosen.

Cognitive behavioral approach : Explain how a cognitive behavioral therapist would approach treatment. Offer background information on cognitive behavioral therapy and describe the treatment sessions, client response, and outcome of this type of treatment. Make note of any difficulties or successes encountered by your client during treatment.
Humanistic approach : Describe a humanistic approach that could be used to treat your client, such as client-centered therapy . Provide information on the type of treatment you chose, the client's reaction to the treatment, and the end result of this approach. Explain why the treatment was successful or unsuccessful.
Psychoanalytic approach : Describe how a psychoanalytic therapist would view the client's problem. Provide some background on the psychoanalytic approach and cite relevant references. Explain how psychoanalytic therapy would be used to treat the client, how the client would respond to therapy, and the effectiveness of this treatment approach.
Pharmacological approach : If treatment primarily involves the use of medications, explain which medications were used and why. Provide background on the effectiveness of these medications and how monotherapy may compare with an approach that combines medications with therapy or other treatments.

This section of a case study should also include information about the treatment goals, process, and outcomes.

When you are writing a case study, you should also include a section where you discuss the case study itself, including the strengths and limitiations of the study. You should note how the findings of your case study might support previous research.

In your discussion section, you should also describe some of the implications of your case study. What ideas or findings might require further exploration? How might researchers go about exploring some of these questions in additional studies?

Need More Tips?

Here are a few additional pointers to keep in mind when formatting your case study:

Never refer to the subject of your case study as "the client." Instead, use their name or a pseudonym.
Read examples of case studies to gain an idea about the style and format.
Remember to use APA format when citing references .

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach . BMC Med Res Methodol . 2011;11:100.

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach . BMC Med Res Methodol . 2011 Jun 27;11:100. doi:10.1186/1471-2288-11-100

Gagnon, Yves-Chantal. The Case Study as Research Method: A Practical Handbook . Canada, Chicago Review Press Incorporated DBA Independent Pub Group, 2010.

Yin, Robert K. Case Study Research and Applications: Design and Methods . United States, SAGE Publications, 2017.

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Usability Redesign Improves Annual Screening Rates in an Ambulatory Setting Case Study

Executive Summary

Improving the usability of electronic health records (EHR) can lead to an improvement in the documentation of key quality measures. The quality measures that were evaluated in this study include screening for Advance Directives, Depression, Falls Risk, and Alcohol and Drug Misuse. A multidisciplinary team at the University of Missouri Health Care undertook a quality improvement project in which the user interface used to prompt and perform annual screening in ambulatory settings was redesigned, and clinical decision support was added to improve visibility and actionability for providers.

As part of the quality improvement project, the existing UI was redesigned, defects were corrected, and screening practices improved. By achieving improvements in task time, error rates, and System Usability Scale scores, the team made significant improvements in identified screening rates after implementation of the redesigned UI compared with the original implementation.

Data prior to implementation of the new UI and the most recent data as of this writing:

Advance Directive Screening improved from 74% in Oct. 2018 to 85% in Dec. 2020.
Depression Screening improved from 40% in Oct.2018 to 60% in Dec. 2020.
Falls Risk Screening improved from 55% to 80% in Dec. 2020.
Alcohol and Drug Misuse Screening improved from 50% to 74% in Dec. 2020.

Lessons learned include:

Do not be afraid to redesign a UI even if it’s been in place for a long time.
Efficiency, effectiveness, and satisfaction can be achieved simultaneously and concurrently along with improved delivery to quality patient care.
Usability Testing has a valuable role in local configurations.
Fewer errors
Fewer clicks
Reduced task time
Better user satisfaction
Improved documentation of quality improvement metrics
Can be used qualitatively to make iterative improvements to solutions
Formal training and prior experience with usability testing is not required (but it helps)
Recruitment of participants can be challenging

Define the Clinical Problem and Pre-Implementation Performance

Annual assessment screens for depression, alcohol and drug misuse, advance directives, and fall risk are part of the routine intake at University of Missouri Health Care ambulatory settings. The screens allow staff and providers to identify those at-risk and target evidence-based interventions.1-3 The intake assessments are documented in the EHR supplier’s user interface (UI) which has been in place for several years. In the course of their clinical work, users encountered nurses and medical assistants who described difficulty with this UI. Staff who have worked in other systems, describe the process of annual assessment screening as “not user friendly” and require “too many clicks.” Often providers aren’t aware when an annual assessment screening for depression, falls risk, alcohol/drug use, or advance directives are due or notified of patients whose screens are positive. These problems potentially contribute to lower-than-expected rates of screening for clinically important conditions. Therefore, a two-phase QI project was undertaken in which the interface underwent a usability-focused redesign, and then clinical decision support (CDS) alerts were added to improve the visibility and actionability of the screening results.

The table below (Table 1) describes the measure, measure description, and measure steward. Three quality measures—advance care planning, depression screening, and fall-risk screening— are quality measures in the Merit-based Incentive Payment System, and data were generated according to definitions used for that program. The fourth measure, alcohol screening, was customized according to requirements for the state Medicaid Primary Care Health Home program.

Table 1. Quality measures used in the project.

In a period of 8 months prior to the intervention, performance had been stable or slightly dropping. The quality metric performance prior to implementation and at the time of this writing are as follows:

Design and Implementation Model Practices and Governance

The multidisciplinary redesign team consisted of physicians, nurses, clinical informaticists, integration architects, ambulatory department quality leadership, and other supporting roles oversaw the QI project. The UI was redesigned over 8 months using a collaborative, multidisciplinary, iterative process. The health system was responsible for the redesign and implementation, and the vendor had no direct role in the process. Health system physicians and nurse informaticists oversaw the work, with input from nurses, medical assistants, administrators, and clinical QI specialists. The team also included system architects, employed by the vendor, responsible for the site- specific implementation.

Summative usability testing was performed as part of the product development and implementation cycle to further develop and evaluate the prototype. The tasks were designed and tested by an ad hoc group of six clinical informaticists with an interest in improving the usability of the vendor’s implementation at the University of Missouri. The group had representation from medical staff, nursing, and solution architects. Summative usability testing demonstrated improvements in task time, error rates, and System Usability Scale scores.

The redesigned UI was deployed in the production environment in June 2019. Staff members were notified of the changes by email. Clinical nursing representatives received a live demonstration and education on the redesigned UI to other staff. No follow-up educational measures were deployed or deemed necessary.

In the second phase of the project, the multidisciplinary team designed CDS alerts for providers using an iterative, user-centered design process. The alerts supported simple, clear entry of clinical interventions related to abnormal screens. Summative usability testing was performed by the same ad hoc group that performed phase one testing. Phase two was implemented April of 2020. Providers received an email notifying them of the implementation, and an educational document with screenshots and instructions was attached. No follow-up educational measures were deployed or deemed necessary.

Overall governance for the project was provided by the University of Missouri Clinical Decision Support (CDS) Oversight Committee. This committee is comprised of nurse leadership, clinical (nurse and physician) informaticists, pharmacists, solution architects, and physician leadership from a range of specialties. The committee approved the project prior to redesign, reviewed summative usability test results, and approved the final implementation.

Clinical Transformation enabled through Information and Technology

From a technology perspective, the vendor’s platform on which the UI is built supported text and date fields, as well as checkbox, radio button, and read only controls. It supported the required settings, simple calculations, default values, and basic conditional application behavior. It did not natively support the complex conditional logic required to accurately prompt annual assessment screening. A novel approach resolved the complex conditional logic at runtime in a separate application program, then sent a “hidden” binary variable to the UI platform, reflecting whether screening was due. The basic conditional application behavior native to the platform then used this variable to produce the proper UI behavior. UI mock-ups based on the heuristic analysis were created to demonstrate proposed changes and to gather input from stakeholders. The design was modified based on feedback from providers, nurses, medical assistants and administrators. Labels were modified for consistency, clarity and the “days since last screening” field was removed. Controls were added with options for documenting the reason screening could not be performed at that encounter (“deferral reasons”). In the final prototype (Fig. 1), one date field was removed, and another was configured to auto populate. The date of prior screening was added to the UI in a read-only format.

Conditional logic used patient age, current problems and date of last screen to generate an unambiguous, color-coded indication that screening is due. Options for deferral reasons were added and conditionally enabled. From the redesigned UI, users could launch modal dialogs which contain the actual screening questions (i.e., the Physician Health Questionnaire-9 for depression screening) by clicking either of the Screen Now options. The fall-risk modal dialog was modified to support interventions to reduce fall-related injury. All four of these modal dialogs were modified to include the current date by default.

Adding “Intelligence” to drive the workflows:

How the proposed design works:

Proposed design:

Team goals included the following UX principles:

Naturalness
Consistency
Minimizing cognitive load
Efficient interactions
Forgiveness and feedback
Effective use of language
Effective information presentation
Preservation of context

In phase two of the project, SmartZone™ CDS alerts were created for providers to notify them when either the screening is overdue or when a screening has been completed and is positive.

Overdue Screening Alert (introduced in April 2020):

The Depression Screening Due, Fall Risk Screening Due, Alcohol/Drug Screening Due, and Advance Directive Screening Due alerts display for patients who are overdue. Providers can also launch interventions documentation directly from the alert and the screening results will display within the form for the provider’s reference.

Figure 6 SmartZone Positive Screen Alert

Improving Adherence to the Standard of Care

Following implementation of phase one, rates of annual screens for alcohol and drug misuse, falls risk, depression, and the provision of advance directives immediately improved. Interrupted time series analysis showed that the phase one UI redesign resulted in significant improvements in the rates of screening in all four annual screening domains. In the original work, the baseline screening rate for the provision of advance directive information was highest of the four metrics at 74.53% and was stable over the pre-implementation phase (0.08% [95% CI: 0.35, 0.19] per month). By the fifth month after implementation of the redesigned UI, the screening rate had increased to 80.13% and was increasing an average of 0.44% [95% CI: 0.10, 0.79] per month, p = 0.017. Depression screening was stable at 38.64% and did not increase prior to implementation, but post-implementation it was increasing by 2.97% [95% CI: 2.50, 3.44] per month, p < 0.0001. Screening for risk of fall improved the most of the four screening metrics, improving by 3.52% [95% CI: 2.92, 4.11] per month, post-implementation; p < 0.0001. While we believe some irregularities in the screening occurred and persisted due to COVID-19, eighteen months post-implementation, these improvements are sustained without any additional changes or educational efforts. Summative usability testing demonstrated improvements in task time, error rates and System Usability Scale scores. Interrupted time series analysis demonstrated significant improvements in all screening rates after implementation of the redesigned UI compared with the original implementation. Data for the study was obtained from the EHR’s core platform. See Table 1 for measure and measure steward.

Self-reported demographics were available for 10 of the 12 participants. They reported a median age range of 40 of 49 and an average of 7.7 years (range: 1–18) of experience with the EHR application. Participants using the redesigned UI had a reduced task time (6.0 vs. 8.3 s; difference in means: 2.3 s; 95% CI [0.9, 3.6]; p = 0.001; ►Table 2), while making fewer errors (0.10 vs. 0.83 errors/task; difference in means: 0.73 errors; 95% CI [0.50, 0.96]; p < 0.0001). Post implementation interviews with staff revealed that in some cases, nursing and medical assistant staff had been completing extra and unnecessary screenings simply because of the uncertainty as to which screens were due. SUS scores were higher for the redesigned UI (96.9 vs. 80.8; difference in means: 16.0; 95% CI [3.0, 29.1]; p = 0.021). The redesigned UI had a higher mean number of clicks (1.2 vs. 0.10; difference in means: 1.1; 95% CI [0.3, 1.8]; p = 0.007). Because the additional deferral fields made the redesigned UI larger, one click on the scroll bar was needed for most users to see the bottom of the redesigned UI, but users did not mention this during testing. We anticipated that from the original UI users might search out the information needed for a screening decision, but they did not. A decision to screen was based almost entirely on the information provided in the UI, for most with no additional clicks at all. There were no significant differences in cursor movement or SEQ scores for tasks requiring identification of overdue screens. The method the nursing and medical assistant staff documented deferral of screening in the existing system was inconsistent across the four screening domains. It required a complex workflow, navigating to other areas of the EHR.

Participants favored the redesigned UI for deferral tasks, with a higher SEQ score (4.91 vs. 3.81; difference in means: 1.01; 95% CI [0.03, 2.15]; p = 0.045) and a reduced task time (12.9 vs. 32.8 s; difference in means: 19.9 s; 95% CI [1.7, 38.1]; p = 0.035; ►Table 2). This implementation did include changes in modal dialog for fall-risk screening which was launched from the redesigned UI and the mean task time for completion of fall-risk screening was lower when the screening was performed from the redesigned UI (9.6 vs. 15.6 s; difference in means: 6.0 s; 95% CI [2.3, 9.7]; p = 0.005). The modal dialogs for depression and alcohol and drug misuse screening did not change, yet the mean task time for completion of these screens was reduced when launched from the redesigned UI (►Figure 8). Total errors were reduced for depression screening with the redesigned UI, but otherwise clicks, cursor movement, error rates, and task-level satisfaction as measured by the SEQ were not significantly different. Comments elicited through a concurrent “think aloud” protocol and retrospective probing aligned with the quantitative findings and did not reveal any additional usability problems with the redesigned prototype UI. No further changes were made prior to implementation.

Summative usability testing demonstrated improvements in task time, error rates and System Usability Scale scores. Interrupted time series analysis demonstrated significant improvements in all screening rates after implementation of the redesigned UI compared with the original implementation.

Numerators and denominators remained generally constant across the project period, and the number of screened patients increased significantly after implementation of the redesigned UI (►Figure 9).

The improvements in the UI led to increased utilization and decreased errors in the documentation of the annual assessment screens. An overall observed improvement in the adherence to documentation requirements was achieved.

Improving Patient Outcomes

In the original work, the usability improvements resulted in significant improvements in the rates of screening in all four annual screening domains. The baseline screening rate for the provision of advance directive information was highest of the four metrics at 74.53% (►Figure 10) and was stable over the pre-implementation phase (0.08% [95% CI: 0.35, 0.19] per month; ►Figure 11). By the fifth month after implementation of the redesigned UI, the screening rate had increased to 80.13% and was increasing an average of 0.44% [95% CI: 0.10, 0.79] per month, p = 0.017. Depression screening was stable at 38.64% and not increasing prior to implementation, but post-implementation it was increasing by 2.97% [95% CI: 2.50, 3.44] per month, p < 0.0001. Screening for risk of fall improved the most of the four screening metrics, improving by 3.52% [95% CI: 2.92, 4.11] per month, postimplementation; p < 0.0001 (Fig. 2).

Sustainment of the improved screening rates has been positive and covers the required 18-month period for submission.

The measure stewards for the annual screenings targeted in the original work all support a preventable negative impact or improved clinical/economical impact when screenings are completed. The screens allow staff and providers to identify at-risk persons and to target evidence-based interventions.1-3 Additional data also supports an improvement in documented depression follow-up plans in conjunction with the improved annual depression screening new UI rollout. The denominator is all Medicare beneficiaries. The numerator is those that were screened and scored negative for depression and those that were screened and scored positive for depression and had follow up if positive.

Data also indicate there has been an increase in Depression Screening, an increase in Depression Screening with Follow-up (DRG data), and an overall decrease in PHQ9 scores. The # of scores in the “Minimal Depressed” interpretation range have increased over time and the # of “Moderate to Severe” interpretation range have decreased over time.

Approach & Definitions

Data extracted from University of Missouri Health P810 Cerner domain
Checked for activity of the ‘Patient Health Questionnaire 9 Score’ event set
Interpretations of PHQ scores (minimal, mild, moderate, moderately severe, and severe) are based on Table 4
Time ranges used
“Before and including May 2019”: 1/1/2017 through 5/31/2019

The percentage of patients with a PHQ score interpretation of ‘minimal’ (score <5) is 9.16% higher since May of 2019. Mild and moderate scores have seen moderate decreases (~5% and ~2.5%, respectively). Moderately severe and severe have seen smaller decreases (~1% and ~0.4%, respectively).

The percentage of patients with a ‘Minimal’ score in 2020 was at least 6.9% higher than any prior year included in the analysis.

The average score has dropped by 0.9 points (8.5  7.6) in the comparison period.

Figure 17 PHQ Score Interpretation Before and After May 2019

Accountability and Driving Resilient Care Redesign

Our findings demonstrate the need for continued attention to improvement of EHR usability for nurses and ancillary staff. Staff members are often responsible for initial screening for depression, alcohol and drug misuse, and fall risk. Nurses share the same usability concerns as physicians. Poor usability of the EHR has been linked to psychological distress and negative work environment among nurses.6,7 In an international survey, nearly one-third of respondents noted problems with system usability.8 In the present study, addressing the usability problems and reducing the associated cognitive load not only reduced task time but also subjectively increased certainty regarding which screens were needed at each encounter. Engaged nurses are an important part of team-based care, and improving EHR effectiveness, efficiency, and satisfaction among nursing staff can be expected to result in improvements in health outcomes for patients. The highly configurable nature of many EHRs allows for significant differences in usability and user experience between sites, even between sites using the same vendor. The American Medical Informatics Association, in their 2013 recommendations for improving usability, advised clinicians to “take ownership” for leading the configuration of the system and adopting best practices based upon the evidence, but stopped short of recommending site-specific usability testing or UCD processes in system configurations. 9 This project also highlights the need for a shared, multi-stakeholder approach to usability at the time of EHR development. Our redesigned interface is built on a vendor-specific platform which, even when optimized, constrains the configurability and usability of the feature. If not required to meet certification criteria, platforms such as the one used in this project may not be subject to usability testing as part of federal certification programs. Health care organizations and providers must work with vendors to continue to enhance such platforms and improve feature functionality that might otherwise constrain site-specific configurations.

The Clinical Informatics Council (CIC) led the education, rollout, and follow-up to ensure proper documentation was completed per policy.

Data examples for measurement have been provided throughout the submission.
The information shared in this submission is based on the article – “The Effect of Electronic Health Record Usability Redesign on Annual Screening Rates in an Ambulatory Setting” in Applied Clinical Informatics, authored by a multidisciplinary team at the University of Missouri Health Care.
O’Connor EA, Perdue LA, Senger CA, et al. . Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2018;320(18):1910–1928
Grossman DC, Curry SJ, Owens DK, et al; US Preventive Services Task Force. Interventions to prevent falls in community-dwelling older adults: US Preventive Services Task Force recommendation statement. JAMA 2018;319(16):1696–1704
Weathers E, O’Caoimh R, Cornally N, et al. . Advance care planning: a systematic review of randomized controlled trials conducted with older adults. Maturitas 2016;91:101–109
Formative vs. summative resear Quick and dirty versus slow and… | by Nick Dauchot | UX Collective (uxdesign.cc)
Siu AL, Bibbins-Domingo K, Grossman DC, et al; US Preventive Services Task Force (USPSTF). Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA 2016;315(04):380–387
Vehko T, Hyppönen H, Puttonen S, et al. . Experienced time pressure and stress: electronic health records usability and information technology competence play a role. BMC Med Inform Decis Mak 2019;19(01):160
Kutney-Lee A, Sloane DM, Bowles KH, Burns LR, Aiken LH. Electronic health record adoption and nurse reports of usability and quality of care: the role of work environment. Appl Clin Inform 2019;10(01):129–139
Topaz M, Ronquillo C, Peltonen LM, et al. . Nurse informaticians report low satisfaction and multi-level concerns with electronic health records: results from an international survey. AMIA Annu Symp Proc 2017;2016:2016–2025
Middleton B, Bloomrosen M, Dente MA, et al; American Medical Informatics Association. Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. J Am Med Inform Assoc 2013;20(e1):e2–e8

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Systematic surveillance tools to reduce rodent pests in disadvantaged urban areas can empower communities and improve public health

One Health promotion and the politics of dog management in remote, northern Australian communities

Reorienting rabies research and practice: lessons from india, introduction.

Population demographics are important baseline data necessary for the study of infectious diseases. Human population data are available in most settings. For animal populations, however, demographic information is very limited in several countries and often only available for specific cohorts or studies. In Thailand, nationwide dog surveys are conducted by local government organizations once or twice a year and reported to a web-based reporting system, “ThaiRabies.net”, which has been updated to “Rabies One Data” since 2021 1 . These surveys require considerable human resources, while the quality of data can vary from province to province depending on the management and training of local staff teams to process and manage data 2 . Here, we proposed an innovative way to conduct dog surveys using a school-based participatory research (SBPR) as a part of community-based participatory research (CBPR), an approach to research that involves collective, reflective, and systematic inquiry in which researchers and community stakeholders engage as equal partners in all steps of the research process, with the goal of educating, improving practice, or bringing about social change 3 , 4 . We implemented the SBPR approach to perform a dog population survey among high school students in Thailand, using a mobile-phone application. This alternative approach relies on a self-reporting system for dog owners. This can be done through a mobile application developed for data collection. This approach was hoped to provide solution of a long-term data collection with lower cost to the government sectors, as well as promote community participations, raising awareness and responsibility among owners to register, monitor, and care for their dogs.

Dog ownership issues are critical for the design of rabies vaccination campaigns, especially in developing countries, including Thailand 5 . In many high-income settings, owners are responsible for properly confining their dogs and facilitating their vaccination against rabies. In Thailand, dog-keeping practices and duties of responsible ownership vary depending on the cultural setting 6 . There is an increasing evidence that most free-roaming dogs are owned and accessible for rabies prophylaxis 7 , 8 , 9 ; moreover, unvaccinated owned dogs have been affected by rabies 2 . Nevertheless, many owners cannot afford to pay for vaccination and other veterinary care for their own dogs 10 , 11 . Thus, many people rely on free, mass vaccination campaigns against rabies, provided by the government or non-governmental organizations (NGOs). In addition, limited access to dog vaccination can potentially reduce effective vaccination coverage, particularly if the proportion of unowned dogs is large. Dog movement patterns can also play a role in rabies epidemiology 12 . Dog confinement has been studied and implemented in some countries as a control measure for rabies 13 , 14 , 15 .

In Thailand, rabies is a notifiable condition, however it is not compulsory to report suspected rabies exposure in humans 16 . Both dog and human vaccination guidelines from the World Health Organization (WHO) and the World Organization for Animal Health (WOAH), recommend a comprehensive strategy to eradicate dog-mediated rabies 17 , 18 , 19 . The strategy highlights the importance of mass dog vaccination campaigns (aiming for at least 70% coverage) and the implementation of effective dog population control measures (e.g. sterilization), which have been optimized for rabies prevention and control 16 , 17 , 18 , 20 . Human rabies in Thailand has been prevented and controlled by policy promulgated since 1992. Rabies cases have decreased because of schemes including mass dog vaccination and sterilization. Although human rabies in Thailand has gradually declined, animal rabies has been generally increasing over the past ten years 2 . In 2020, there were 209 cases of rabid dogs reported in Thailand and three human deaths due to rabies. Rabies is most prevalent in the provinces of Chonburi, Songkhla, and Surin, while Chiang Rai has found high positive detection of rabid animal cases in 2018 21 , 22 . The control of rabies in animals is challenging, as the disease can be transmitted throughout the year and therefore surveillance and control of animal carriers are urgently required 20 . As for the Thai government’s policy and guideline (based on WHO & WOAH) for high-risk areas, ring vaccination is currently implemented for controlling and preventing rabies outbreaks, while sterilization is a long-term solution to control number of dog population, reducing contacts among dogs and between human and dogs. Both vaccination and sterilization are hopeful for improve management of dog bites 22 .

Although the database of dogs has been significantly improved following the introduction of dog survey reporting to ThaiRabies.net by local government organizations, the system still relies solely on the public health sectors. Moreover, data consistency remains an issue due to technical problems within the system and incomplete data entry. Here, we introduced a novel method for owned-dog data collection, using the SBPR approach. Information about dog population dynamics is essential for analyzing population and disease prediction and can act as baseline data for dog population management plans. The exploration and identification of dog population ecosystems and dynamics are required as a framework to effectively plan and evaluate population management and interventions to prevent rabies 8 . In addition, the introduction of an approach to our dog survey among school-age children could be beneficial in terms of generating awareness of animal-care practices, disease, and the development of a research mindset.

Countries in Southeast Asia are among the top users of mobile phones globally. In 2020, total population of Thailand were approximately 65.42 million 23 . The number of smartphone users in Thailand reached 53.57 million, with around 60 million predicted by 2026, due both to increases in the Thai population and internet penetration 24 . Self-reported data collection via mobile phones can be of use when conducting large-scale surveys, with the affordability and availability of mobile phones and wireless networks making them a viable alternative to traditional methods 25 . However, it is important to consider various aspects involved in the development and implementation of mobile phone data collection. For example, ensuring usability and user acceptance of the data collection system will help motivate survey participants to stay with the project and continue to provide high-quality data. Server authentication through the use of properly configured certificates will help deal with threats of data submission to a malicious server, which can increase users’ confidence in data security 26 .

Our study proposed an initial effort to conduct a long-term survey based on dog owners’ awareness and participation. The dog population dynamics data were analyzed and visualized. In addition, the qualitative study was performed on 10% of the survey participants who volunteered to do the interview on knowledge of rabies, social responsibility, community engagement and research orientation. The data collection tools and methods were assessed and further improvements when using this approach were proposed.

Dog population survey

School and participant demographics.

In the survey via ‘Pupify’ mobile application, 303 high-school students registered through the mobile application for our study. There were 29.8%, 28.9%, 27.1% and 14.2% from a school in Chonburi, Surin, Chiang Rai, and Songkhla provinces, respectively; most were female participants (72.9%) (Table 1 ). Of 303 registrations, 218 participants actually submitted at least one update of their dogs into the system over the one-year study. However, the number of participants continued submitting the monthly dog updates dropped to 46, 63 and 43 after 6 months, 9 months and by the end of one year, respectively. The number of students giving the completely one-year updates was 43 or 20% of total participants from the start (Fig. 1 ).

A number of participants’ responses in a 3-month period during the study year.

Dog demographics and dog population dynamics

Overall, 322 owned dogs were reported during the study period. More than half were male dogs (65.0%). Owned dogs were divided into three age groups based on owners′ identification: birth to 1 year (28.3%), aged between > 1 and 8 years (57.1%), and aged > 8 years (14.6%). These age classes were used to represent three groups of dogs, puppy, adult, and elderly. Most owned dogs were reported in Surin province (35.4%), followed by Chiang Rai (28.5%), Chonburi (22.7%), Songkhla (12.1%), and others where owners dwelling in adjacent areas (1.2%). In addition, 24 new-born puppies were reported, while there were 20 deaths (e.g. caused by dog illness, bite, fight, accident, and culling) and 9 missing dogs reported. These numbers correspond to the estimated birth, death, and missing rates of 7.5, 6.2, and 2.7 per 100 dog-years, respectively. Based on the self-reporting system, 40.1% of the dogs had been vaccinated against rabies and 12.4% had been sterilized (Table 2 ).

Qualitative study

Dog owner characteristics.

A total of 23 high-school students, all aged 17 years, voluntarily participated in our interview (see Supplementary Table 3 ). There were students from all three levels of participation, including registration only (17.4%, n = 4), partially updated data (39.1%, n = 9), and fully updated data (43.5%, n = 10). Although all schools from four provinces were represented, more than half of the participants were from Chonburi province (52.2%).

Extensive knowledge and dog rabies awareness

Most participants (91.3%, n = 21) strongly agreed that rabies was fatal, resulting in death in both humans and dogs. One participant noted, “I learned from the news on TV that human infections result in a hundred percent mortality” . However, 52.1% of the participants (n = 12) reported that they were either unaware of or did not follow rabies situations locally. This indicated that while most participants are aware of rabies, they do not necessarily stay informed about local rabies situations. One participant said, “ I have very little experience of rabies disease. I have not seen the real case before and have not followed the disease situation. At school, there is minimal information for us to research more about rabies. Sometimes, external health staff came to educate us about health at school but didn’t focus on rabies” . While a majority (65.2%, n = 15) of participants considered that only cats and dogs were reservoirs for rabies, a larger proportion (78.2%, n = 18) were unsure whether there were other animal reservoirs. This result indicated that most participants were unaware that other mammals can also get infected with rabies. From the interviews, some participants made statements such as “I think it mainly comes from dogs and cats, unlikely to be other species” and “Most cases are infected from stray dogs, perhaps also from rabbits and monkeys” . In addition, 65.0% (n = 15) of participants mainly received information about rabies from social media and other online sources, while the remaining participants obtained information from other sources, including schools (such as our project visit), television and news, community announcements, medical providers, parents, and relatives.

Rabies precautions and caring for owned dogs

Most participants (87.0%, n = 20) stated that avoiding contact with stray dogs can help to prevent rabies infection. Also, 52.1% (n = 12) suggested that owned dogs should be vaccinated annually against rabies. Dog confinement was reported by most owners (87.0%, n = 20) as a way to control and limit their dogs’ contact with humans or animals. One participant said, “I keep my dog only in my house to avoid contacting with people and other dogs” and “My dog is always leashed all the time and I don’t allow other dogs nearby my dog when it is outside” . According to this, half of them (52.1%, n = 12) trusted their dogs, with 80–100% confidence due to annually vaccination and not allowing dogs outside. One participant said, “Some of my dogs are not yet vaccinated, we put the dogs to guard our properties in the factory area and sometimes outside dogs do come to visit” .

In terms of caring for owned dogs, participants reported how they managed their dog’s health (including regular health check-ups and visits to veterinarians when health issues were identified). The majority used the services of animal clinics (87.0%, n = 20), followed by animal hospitals (21.7%, n = 5), treatment by owners (21.7%, n = 5), and government veterinary services (13.0%, n = 3). However, one said, “I saw my aunt giving paracetamol to the dog when it was sick. I didn't agree with that and would have looked for more information or taken the dog to the vet instead” . This indicated that animal health education on the care of owned dogs should be enhanced, with information provided by specialists at animal service stations.

In the case of what happens to newborn puppies, participants identified two common situations: giving them away to others (65.2%, n = 15) and keeping the puppies themselves (39.1%, n = 9). In the mating season, most participants said they confined their dogs and did not allow them to breed with other dogs. One participant said, “I usually keep the dog in the house and sometimes use a lease to prevent dogs fighting”. Conversely, in the case of both neutered and non-neutered dogs, some participants still allowed their dogs to breed. Finally, the owners said they commonly observed their dog’s health status at feeding time (47.8%, n = 11); when they were sleeping (30.4%, n = 7) or playing (17.4%, n = 4); or when they observed any abnormality (17.4%, n = 4).

Obstacles, limitations, and motivations for joining in with school-based participatory research

Obstacles and limitations relating to the SBPR study mentioned by participants included forgetting to update their dog’s data (65.2%, n = 15), having school assignments and portfolios (30.4%, n = 7), having a part-time job (17.4%, n = 4), having personal works (17.4%, n = 4), having a poor internet connection (13.0%, n = 3), changing their smartphone (8.7%, n = 2), being unable to install the mobile application (4.3%, n = 1), and not interested in participating (4.3%, n = 1).

Conversely, participants reported some interesting advantages and motivations for why they participated in this study. Motivations included in the attainment of project certificates (60.9%, n = 14), followed by project rewards/gifts (34.8%, n = 8), research experience (13.0%, n = 3), dog care and follow-up (13.0%, n = 3), and rabies information (4.3%, n = 1). Other influences for joining the project mentioned included own self (65.2%, n = 15), project notification (13.0%, n = 3), project rewards (8.7%, n = 2), and support for school activities (4.3%, n = 1). After participated in this study, the main advantages given were mostly focused on caring for owned dogs, with regard to dog attention and care (69.6%, n = 16), observation of dog behavior (34.8%, n = 8), dog vaccine notification (17.4%, n = 4), and education (17.4%, n = 4). One mentioned that “In my opinion, the best thing I learned is to pay more attention to my dog. I observe my dogs more regularly and take care of them much better than earlier” .

Other suggestions from participants

Some participants suggested that they needed more information about rabies disease, its prevention and control, dog management, and dog vaccination. This could be added to the Pupify application, which was easily accessible for necessary information. Also, alternative sources of information should be considered, e.g., infographics and dog fan-pages on Facebook, Instagram, Twitter, or other popular social media platforms. One participant suggested, “I think having different channels for communication would help stimulate more interest in the work, for example, forming a ‘dog lovers’ group on social media” .

Here, we explored a new method to collect dog data via mobile application, a self-reporting system for dog owners, by focus initially on high school students who owned smartphones, which is in contrast with the conventional dog population census that is performed once or twice per year in Thailand by the government departments responsible for animal health. The key challenge to our design was the number of losses to follow-up. Our qualitative study revealed the main barriers to update dog dynamics data were due to some personal issues and technical reasons. A participant from the partial update group noted, “I gave regular updates until I changed my smart phone, I stopped updating the information completely” . One from the no-update group said, “I had difficulties installing the app and I think I am not disciplined enough to join this project anyway”. In addition, there was some feedback on the suitability of a mobile instant messaging app for data tracing. One participant suggested, “I prefer other channels of communication such as Instagram and Facebook because they are more convenient to me” .

Nevertheless, we estimated birth, death, and missing rates of 7.5, 6.2, and 2.7 per 100 dog-years, respectively. The male to female ratio was approximately 1.8:1. The variations in these rates and ratios among the studied provinces are noticeable (see Supplementary Tables 1 and 2 ). This could be due to different nature of owned dogs in different parts of Thailand. However, due to the relatively small sample size in our study, it would not be appropriate to perform any sub-analysis from this data. It is important to note that the majority of the data provided pertained to confined dogs (70.2%), which may not accurately reflect the uncertainty conditions of free-roaming dogs. Future dog censuses should include a focus on confined, free-roaming, and stray dogs to provide a more comprehensive representation of the overall dog population size. Observations in South Africa revealed that birth and death rates were 31.3–45.1 and 40.6–56.8 per 100 dog-years, respectively, while the male to female ratio was approximately 1.4–1.7:1 27 . A study in India estimated an annual per capita birth and death rate of 1.0 and 0.7, respectively, while the male to female ratio was approximately 1.4:1 28 . A sight–resight survey in Australia reported birth and death rates were approximately 2.4 and 1.7 dogs/dog-owning house/year, respectively, while the male to female ratio was approximately 1:1 7 . Compared with other studies (using different approaches to collect the data; including observational, sight-resight, and/or mark-recapture survey), births and deaths in our study were relatively low. However, the male to female ratio was in line with previous studies. Similarly to a previous study 6 , we found the proportions of dog-keeping approaches (i.e. confined or free-roaming) varied among the sites, with dogs usually confined in well-developed areas whereas free-roaming dogs were reported more frequently in remote areas.

Our study had some limitations. First, the survey was restricted to owned dogs. It would be helpful to collect similar data for stray dogs; however, to conduct a similar study of stray dogs in the Thai setting, individuals who take care of stray dogs, so called “local feeders”, must be identified 29 . Second, the participants only comprised high-school children of a specific age group, perhaps a broader target public population should be considered for future surveys. Furthermore, we simply used three reproductive age classes to represent puppy, adult, and elderly i.e. the exact dog ages as detailed classifications, i.e. puppy, juvenile, young adult, mature adult, senior, and geriatric, are not available in this study. Third, the 'Pupify' application was developed for Android phones only and required updates to remain compatible with the latest operating system versions. Fourth, there was a low number of one-year data completion among the participated students who owned a mobile phone. Because the participation was voluntary, unrelated to school nor teacher’s request. The study sites were distant from the central project location, notifications and encouragement communications were conducted solely via Line messaging application and telephone calls. This led to discontinuities in communication between the researchers and the students throughout the year. The barriers in our SBPR engagement were limitations of the mobile application platform, technical issues, personal reasons, and the lack of engagement of project through the teachers and/or schools. Further studies should consider site visits to enhance communication, encourage participation, and investigate any arising issues.

In accordance with “One Health” concepts, human health is closely connected to the health of animals and our shared environment, and research in this area should be a collaborative, multisectoral, and trans-disciplinary approach to achieve optimal health outcomes. We made considerable effort to use the SBPR approach in conducting this study. In addition, the initial motivation for study participation was primarily driven by the desire to achieve long-term goals and enhance their profiles for university enrollment. After participating, they also recognized considerable benefits in caring for their dogs and demonstrated a commitment to sustainable effort for better dog care. Although there was a low response rate among participants, we could remark that the main advantage concerning caring for owned dogs was initially successful based on participants’ perception. Most interviewees agreed that this study would encourage them to pay more regular attention to their dogs regarding their health, vaccinations, and rabies prevention. Our study demonstrated the importance of encouraging, among school-age children, early learning about the importance of disease prevention and awareness, together with community engagement and social responsibility for their future. Finally, it is important to note that the success of several research depends on effective data collections. However, this study has provided valuable lessons, demonstrating that engaging the general public, beyond researchers and experts, presents considerable challenges. Practical issues such as invitations, communications, cooperations, maintaining engagements, and overall participations should be carefully considered. We hope that the insights gained from our study with SBPR may be beneficial for further studies and similar contexts.

Conclusions

Using the SBPR approach for collecting dog population dynamics data among the high school students can be challenging. Additionally, this study was conducted with an initial effort to explore the potential of using SBPR for data collection. The primary objective aimed to propose extending the approach beyond student awareness to include general dog owners in further research. Implementing a suitable SBPR approach involves designing educational activities, training participants, conducting surveys, and engaging the community. This could lead to effective and sustained data collection while fostering community involvement and awareness in the future. Perception on the usefulness of the application and different social-media channels for communication should be considered for future development of data collecting tools and mobile application in order to provide higher incentive to participate and update dog information in a long-term. A low level of disease awareness among high school students was identified in the interviews, possibly due to insufficient information, both at school and in the media. It is critical to promote disease awareness through health education. Further studies using in-depth interviews should focus on enhancing rabies awareness, increasing owner responsibility, and supporting rabies prevention projects, as these factors are crucial for policymaking and effective public participation. Nevertheless, by conducting data collection using a new alternative approach among the students, it has clearly increased some awareness on the importance of animal welfare and provided some new experience of being part of a research for some students to reduce rabies among humans and animals.

Study sites and participants

This study was conducted between June 2018 and October 2019, in areas where rabies is endemic and where there is a high incidence of animal and human cases 30 . It formed part of a larger study conducted in Thailand between 2015 and 2018, which aimed to investigate the cultural and socioeconomic factors that contribute to rabies outbreaks in Thailand 31 . Four provinces were included: Chiang Rai province in the north, Surin province in the northeast, Chonburi province in the east, and Songkhla province in the south (Fig. 2 ). Based on the past five year report of rabies in Thailand 22 , 30 , we purposively surveyed high school students dwelling in high endemic areas among the four provinces. Inclusion criteria were: (1) students aged between 16 and 17 years who owned at least one dog and possessed a smartphone that used the Android operating system, and (2) volunteer students whose parents consented to their participation in the study. In this study, dog ownership was defined as those who owned or cared for at least one dog at the residence only. Students were eligible to voluntarily participate by registering dog data on the ‘Pupify’ application.

Maps showing; laboratory positive detection of rabies cases in animals in 2018 (Source: Thairabies.net: http://www.thairabies.net 1 ; and The four provinces included in the study: Chiang Rai, Surin, Chonburi, and Songkhla.

Data collection using the “Pupify”

‘Pupify’ mobile application was developed to collect long-term data on dog population numbers and dynamics from dog owners, feeders, and the general public. The ‘Pupify’ was developed by a group of university students from the Department of Computer Engineering, Chulalongkorn University 32 . The software architecture was three-tiered i.e. client, application server, and database server. The client section was initially constructed for Android OS using Java language. The application server was developed by using JavaScript which responded to user requests and monitored the types of data that should be recorded in the database server. All processes were tested accurately in both software testing and acceptance testing by developers and research team to ensure that the application can function in real settings.

In this study, the application was initially designed to target high-school students who have a smartphone and presumably have good knowledge of rabies. The application was developed in collaboration with the Department of Livestock Development (DLD), Ministry of Agriculture and Cooperatives Thailand, who are responsible for rabies control in Thailand. The application comprised three main sections: (i) demographic information about a dog’s owner, (ii) demographic information about dogs, and (iii) routine information updates and report management. The first and second sections were recorded in literal format once for each dog and owner upon registration. Monthly updates were required to follow-up on status of registered dogs, e.g. still alive, moved out, dead, vaccination status, and sterilization status. The participants were reminded to provide at least the monthly updates through the application and other channels of communication including Line messaging application and telephone calls with the researchers.

Qualitative study for the evaluation of participatory research

The second part of the study was conducted once the dog survey had been completed. This qualitative study aimed to explore in detail the knowledge, perceptions, and awareness of dog owners with regard to rabies in dogs and humans. Semi-structured interviews were used to collect the information. First, the participants from the survey were asked to voluntarily participate in the qualitative study by registering online to express their interest. To ensure a diversity of data, the research team purposively selected participants to include students whose duration of participation in the dog survey varied and those who attended different schools. Second, they were invited to participate in a one-to-one online interview with Thichumpa W. Each interview lasted for 15–30 min and was recorded. Informed consent was obtained from all participants’ parents. The interviews were conducted between March to May 2021.

The study protocol was approved by the ethical committees of Mahidol University Central Institutional Review Board (MU-CIRB 2019/157.0606; August 2019). Written informed consent was obtained from all high school students who participated in the research. All the methods were performed in accordance with relevant guidelines and regulations.

Data analyzes

Descriptive statistics were generated using SPSS version 23.0 33 . For the qualitative study, transcript data were evaluated by determining the frequency of answers given by interviewees and then coding keywords into pre-set themes 34 , including the theme of rabies knowledge, rabies awareness, caring for owned dog, perception about project, and other suggestions. The content analysis and thematic narrative approach were performed using QDA Miner Lite 35 .

Data availability

The data that support the findings of this study are available from the corresponding author, (WP), upon reasonable request.

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Acknowledgements

We cordially thank all the high school students who participated in our surveys. We also thank Siwakorn Luengcharoenpong and the teams from the Department of Computer Engineering, Chulalongkorn University, Bangkok, Thailand for software development and consultation.

This study was funded by the National Science and Technology Development Agency (NSTDA), Thailand (Grant ID. P-18-51758) and the Disease Control Department, Ministry of Public Health, Thailand. In addition, this research was funded in part by the Wellcome Trust [220211]. For the purpose of Open Access, the authors have applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission.

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Conceptualization and Methodology: WK.T., W.P., C.M., A.W. and WP.T. Mobile application: S.P. and N.P. Survey and data collection: WK.T., S.S., C.S., O.S., S.PR., WP.T. and A.C. Formal analysis: WK.T. and W.P. Project administration and data management: WK.T. Writing–original draft: WK.T. and W.P. Writing–review & editing: All authors. The authors declare consent for publication.

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Thichumpa, W., Wiratsudakul, A., Suwanpakdee, S. et al. Study of dog population dynamics and rabies awareness in Thailand using a school-based participatory research approach. Sci Rep 14 , 20477 (2024). https://doi.org/10.1038/s41598-024-71207-7

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Environmental impacts of extensive beef production in Colombia by life cycle assessment: a case study

Research Article
Published: 07 September 2024

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Sara Arcila 1 ,
Natalia Correa 1 ,
Sebastián Pachón 2 ,
Luis Giraldo A. Valderrama 2 &
Natalia A. Cano-Londoño ORCID: orcid.org/0000-0003-4828-6442 3 , 4

The increase in the negative effects of global change promotes the search for alternatives to supply the demand for food worldwide aligned with the Sustainable Development Goals (SDGs) to ensure food security. Animal protein, which is a main source of nutrients in the diet of today’s society, especially beef, which is one of the most demanded products nowadays, has been criticized not only for its high water consumption and land occupation for production but also for the emission of greenhouse gases (GHG) from enteric methane generated in the fermentation process within the bovine rumen and deforestation for the adaptation of pastures. This study is mainly motivated by the lack of quantifiable scientific information in Colombia on the environmental impacts of beef production. Therefore, it is intended to estimate some of the impacts of beef production in extensive systems using the life cycle assessment (LCA) method under a particular scenario considering all the production phases (from raw material to fattening, where the cattle are ready to be slaughtered). The study was conducted with data supplied by a farm in Antioquia, Colombia, and the functional unit (FU) was defined as 1 kg of live weight (LW). The scope of this study was gate-to-gate. “The 2019 Refinement to the 2006 IPCC Guidelines for National Greenhouse Gas Inventories” (IPCC 2006 ; IPCC 2019 ) was used to calculate methane and nitrous oxide emissions. LCA modeling was developed with Ecoinvent database v3.8 and the Umberto LCA + software. It was found that the most affected category of damage was ecosystem quality, which represents 77% of the total, followed by human health at 17% and resources at 6%. The category impact of agricultural land occupation is the one that represents the most significant contribution to the ecosystem quality endpoint, with a percentage of 87%, due to the soil’s compaction and the loss of the soil’s properties. Additionally, the obtained carbon footprint for the system was 28.9 kg of CO 2 -eq/kg LW.

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Acknowledgements

To the coauthors for their expertise and assistance throughout all aspects of our study and for their help in writing the manuscript.

To research group BIORUM of the Science Faculty of the National University of Colombia.

To research group Fenómenos de Superficie-Michael Polanyi of the Mining Faculty of the National University of Colombia.

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Sara Arcila & Natalia Correa

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Sebastián Pachón & Luis Giraldo A. Valderrama

Grupo de Investigación en Fenómenos de Superficie-Michael Polanyi, Facultad de Minas, Universidad Nacional de Colombia−Sede Medellín, 050041, Medellín, Colombia

Natalia A. Cano-Londoño

Research Group Sustainable Systems Engineering (STEN), Ghent University, Coupure Links 653, 9000, Ghent, Belgium

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All authors contributed to the study’s conception and design. Sara Arcila, Natalia Correa, and Sebastián Pachón prepared materials, collected data, and analyzed them. Natalia A. Cano-Londoño and Luis Giraldo-Valderrama supervised them. Natalia Correa and Sebastián Pachón wrote the first draft of the manuscript, and all authors commented on previous versions. All authors read and approved the final manuscript.

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• Enteric methane emissions from manure management and direct/indirect nitrous oxide emissions from manure and soil management were calculated for suckling calves, growing, breeding stock, and fattening phases.

• LCA allows analyzing the environmental impacts of livestock farming in Colombia, which may not have been previously considered.

• This LCA supports environmental decision-making and formulating sustainable livestock policies and projects of best agricultural practices.

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Arcila, S., Correa, N., Pachón, S. et al. Environmental impacts of extensive beef production in Colombia by life cycle assessment: a case study. Environ Sci Pollut Res (2024). https://doi.org/10.1007/s11356-024-34463-8

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5 Benefits of the Case Study Method
5 Benefits of the Case Study Method - HBS Online
What the Case Study Method Really Teaches
What the Case Study Method Really Teaches
Case study
In sociology, the case-study method was developed by Frédéric Le Play in France during the 19th century. This approach involves a field worker staying with a family for a period of time, gathering data on the family members' attitudes and interactions and on their income, expenditures, and physical possessions. ...
What is the Case Study Method?
Simply put, the case method is a discussion of real-life situations that business executives have faced. Harvard Business School. The Learning Experience. The Case Study Method. On average, you'll attend three to four different classes a day, for a total of about six hours of class time (schedules vary). To prepare, you'll work through problems ...
The Case Study Approach
The case study approach to research in the social sciences is a fitting method for identifying the interaction between individuals, messages, and context. Yin ) summarizes, "The case study method allows investigators to retain the holistic and meaningful characteristics of real-life events" (p. 2). The case study approach works well to ...
Case Study: Definition, Examples, Types, and How to Write
Case Study: Definition, Examples, Types, and How to Write
Two Assessment Methods Case Study 3 (docx)
TWO ASSESSMENT METHODS CASE STUDY 2 Case Study Phonemin Company, a seasonal clothing catalog retailer, anticipates a significant increase in phone orders. To improve customer service effectiveness and potentially boost revenue, they aim to enhance their Customer Service Representative (CSR) selection process. Currently, staffing relies on newspaper ads and employee referrals.
Construction method and case study of digital twin system for combine
This study proposes a methodology for developing a digital twin system for the combine harvester. As shown in Fig. 1, the digital twin system consists of a physical system, a virtual system, model calculation, a data interaction system, and a human-machine interaction system.The physical system encompasses the actual structure and functional components of the combine harvester.
Usability Redesign Improves Annual Screening Rates in an Ambulatory
This HIMSS Davies Award case study focuses on one health system's work to improve the usability of electronic health records (EHR) to lead to an improvement in the documentation of key quality measures. ... A novel approach resolved the complex conditional logic at runtime in a separate application program, then sent a "hidden" binary ...
Study of dog population dynamics and rabies awareness in ...
In conclusion, this study focused on using the SBPR approach via mobile application to collect data informing dog population dynamics and raising awareness regarding rabies in Thailand Other ...
Water
As one of the most catastrophic geologic disasters [1,2], debris flow disasters cause serious economic losses and casualties every year, posing a great threat to socio-economic development and the safety of human life and property [3,4].Debris flow monitoring is a prior means of the related research, which provides the basis for its theoretical study, experimental study, mechanism analysis ...
Environmental impacts of extensive beef production in ...
Description of the extensive beef production system. The study was based on data from the extensive beef production farm in Las Malvinas village in the municipality of Caucasia (Fig. 2), located in the Bajo Cauca subregion of the department of Antioquia, Colombia.Livestock farming is a relevant activity in the Bajo Cauca subregion; however, it is practiced in extensive systems with little ...

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Case Study – Methods, Examples and Guide

Types of Case Study

Single-Case Study

Multiple-Case Study

Descriptive Case Study

Instrumental Case Study

Case Study Data Collection Methods

Observations

How to conduct Case Study Research

Examples of Case Study

Application of Case Study

Business and Management

Social Sciences

Law and Ethics

Purpose of Case Study

Advantages of Case Study Research

Limitations of Case Study Research

About the author

Muhammad Hassan

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The Ultimate Guide to Qualitative Research - Part 1: The Basics

Research question

Data collection

What is a case study?

Case studies

Definition of a case study

Characteristics of case studies

The role of case studies in research

What is the purpose of a case study?

Why use case studies in qualitative research?

The explanatory, exploratory, and descriptive roles of case studies

The impact of case studies on knowledge development

Types of case studies

Exploratory case studies

Descriptive case studies

Explanatory case studies

Intrinsic, instrumental, and collective case studies

Critical information systems research

Health research

Asthma research studies

Other fields

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Propositions

Units of analysis

Argumentation

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Defining the research question

Selecting and defining the case

Developing a detailed case study protocol

Collecting data

Analyzing and interpreting data

Writing the case study report

Observations

Documents and artifacts

Ensuring the quality of data collection

Data analysis

Organizing the data

Categorizing and coding the data

Identifying patterns and themes

Interpreting the data

Verification of the data

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Case Study | Definition, Examples & Methods

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